Background: Telemedicine and mobile health (mHealth) apps have emerged as powerful tools in health care, offering convenient access to services and empowering participants in managing their health. Among populations with chronic and progressive disease such as multiple sclerosis (MS), mHealth apps hold promise for enhancing self-management and care. To be used in clinical practice, the validity and usability of mHealth tools should be tested. The most commonly used method for assessing the usability of electronic technologies are questionnaires.
Objective: This study aimed to translate and validate the English version of the mHealth App Usability Questionnaire into Italian (ita-MAUQ) in a sample of people with MS.
Methods: The 18-item mHealth App Usability Questionnaire was forward- and back-translated from English into Italian by an expert panel, following scientific guidelines for translation and cross-cultural adaptation. The ita-MAUQ (patient version for stand-alone apps) comprises 3 subscales, which are ease of use, interface and satisfaction, and usefulness. After interacting with DIGICOG-MS (Digital Assessment of Cognitive Impairment in Multiple Sclerosis), a novel mHealth app for cognitive self-assessment in MS, people completed the ita-MAUQ and the System Usability Scale, included to test construct validity of the translated questionnaire. Confirmatory factor analysis, internal consistency, test-retest reliability, and construct validity were assessed. Known-groups validity was examined based on disability levels as indicated by the Expanded Disability Status Scale (EDSS) score and gender.
Results: In total, 116 people with MS (female n=74; mean age 47.2, SD 14 years; mean EDSS 3.32, SD 1.72) were enrolled. The ita-MAUQ demonstrated acceptable model fit, good internal consistency (Cronbach α=0.92), and moderate test-retest reliability (intraclass coefficient correlation 0.84). Spearman coefficients revealed significant correlations between the ita-MAUQ total score; the ease of use (5 items), interface and satisfaction (7 items), and usefulness subscales; and the System Usability Scale (all P values <.05). Known-group analysis found no difference between people with MS with mild and moderate EDSS (all P values >.05), suggesting that ambulation ability, mainly detected by the EDSS, did not affect the ita-MAUQ scores. Interestingly, a statistical difference between female and male participants concerning the ease of use ita-MAUQ subscale was found (P=.02).
Conclusions: The ita-MAUQ demonstrated high reliability and validity and it might be used to evaluate the usability, utility, and acceptability of mHealth apps in people with MS.
Background: Clinical trials are essential for medical research and medical progress. Nevertheless, trials often fail to reach their recruitment goals. Patient recruitment systems aim to support clinical trials by providing an automated search for eligible patients in the databases of health care institutions like university hospitals. To integrate patient recruitment systems into existing workflows, previous works have assessed user requirements for these tools. In this study, we tested patient recruitment systems KAS+ and recruIT as part of the MIRACUM (Medical Informatics in Research and Care in University Medicine) project.
Objective: Our goal was to investigate whether and to what extent the 2 different evaluated tools can meet the requirements resulting from the first requirements analysis, which was performed in 2018-2019. A user survey was conducted to determine whether the tools are usable in practice and helpful for the trial staff. Furthermore, we investigated whether the test phase revealed further requirements for recruitment tools that were not considered in the first place.
Methods: We performed semistructured interviews with 10 participants in 3 German university hospitals who used the patient recruitment tools KAS+ or recruIT for at least 1 month with currently recruiting trials. Thereafter, the interviews were transcribed and analyzed by Meyring method. The identified statements of the interviewees were categorized into 5 groups of requirements and sorted by their frequency.
Results: The evaluated recruIT and KAS+ tools fulfilled 7 and 11 requirements of the 12 previously identified requirements, respectively. The interviewed participants mentioned the need for different notification schedules, integration into their workflow, different patient characteristics, and pseudonymized screening lists. This resulted in a list of new requirements for the implementation or enhancement of patient recruitment systems.
Conclusions: Trial staff report a huge need of support for the identification of eligible trial participants. Moreover, the workflows in patient recruitment differ across trials. For better suitability of the recruitment systems in the workflow of different kinds of trials, we recommend the implementation of an adjustable notification schedule for screening lists, a detailed workflow analysis, broad patient filtering options, and the display of all information needed to identify the persons on the list. Despite criticisms, all participants confirmed to use the patient recruitment systems again.
Background: Previous studies have evaluated the accuracy of the diagnostics of electronic symptom checkers (ESCs) and triage using clinical case vignettes. National Omaolo digital services (Omaolo) in Finland consist of an ESC for various symptoms. Omaolo is a medical device with a Conformité Européenne marking (risk class: IIa), based on Duodecim Clinical Decision Support, EBMEDS.
Objective: This study investigates how well triage performed by the ESC nurse triage within the chief symptom list available in Omaolo (anal region symptoms, cough, diarrhea, discharge from the eye or watery or reddish eye, headache, heartburn, knee symptom or injury, lower back pain or injury, oral health, painful or blocked ear, respiratory tract infection, sexually transmitted disease, shoulder pain or stiffness or injury, sore throat or throat symptom, and urinary tract infection). In addition, the accuracy, specificity, sensitivity, and safety of the Omaolo ESC were assessed.
Methods: This is a clinical validation study in a real-life setting performed at multiple primary health care (PHC) centers across Finland. The included units were of the walk-in model of primary care, where no previous phone call or contact was required. Upon arriving at the PHC center, users (patients) answered the ESC questions and received a triage recommendation; a nurse then assessed their triage. Findings on 877 patients were analyzed by matching the ESC recommendations with triage by the triage nurse.
Results: Safe assessments by the ESC accounted for 97.6% (856/877; 95% CI 95.6%-98.0%) of all assessments made. The mean of the exact match for all symptom assessments was 53.7% (471/877; 95% CI 49.2%-55.9%). The mean value of the exact match or overly conservative but suitable for all (ESC's assessment was 1 triage level higher than the nurse's triage) symptom assessments was 66.6% (584/877; 95% CI 63.4%-69.7%). When the nurse concluded that urgent treatment was needed, the ESC's exactly matched accuracy was 70.9% (244/344; 95% CI 65.8%-75.7%). Sensitivity for the Omaolo ESC was 62.6% and specificity of 69.2%. A total of 21 critical assessments were identified for further analysis: there was no indication of compromised patient safety.
Conclusions: The primary objectives of this study were to evaluate the safety and to explore the accuracy, specificity, and sensitivity of the Omaolo ESC. The results indicate that the ESC is safe in a real-life setting when appraised with assessments conducted by triage nurses. Furthermore, the Omaolo ESC exhibits the potential to guide patients to appropriate triage destinations effectively, helping them to receive timely and suitable care.
International registered report identifier (irrid): RR2-10.2196/41423.
Background: Remote patient monitoring (RPM) aims to improve patient access to care and communication with clinical providers. Overall, understanding the usability of RPM applications and their influence on clinical care workflows is limited from the perspectives of clinician end users at a cancer center in the Northeast, United States.
Objective: Explore the usability and functionality of RPM and elicit the perceptions and experiences of oncology clinicians using RPM for oncology patients after hospital discharge.
Methods: The sample included 30 of 98 clinicians (31% response rate) managing at least five patients in the RPM program and responding to the m-Health Usability between March 2021- October 2021. Overall, clinicians responded positively to the survey. Item responses with the highest proportion of disagreement were explored further. A nested sample of five clinicians who responded to the study survey (30% response rate) participated in interview sessions conducted from November 2021 to February 2022, and averaged 60 minutes each.
Results: Survey responses highlighted that RPM was easy to use and learn and verified symptom alerts during follow-up phone calls. Areas to improve identified practice changes from reporting RPM alerts through digital portals and its influence on clinicians' workload burden. Interview sessions revealed three main themes: clinician understanding and usability constraints, patient constraints, and suggestions for improving the program. Subthemes for each theme were explored, characterizing technical and functional limitations that could be addressed to enhance efficiency, workflow, and user experience.
Conclusions: Clinicians support the value of RPM for improving symptom management and engaging with providers. Functional changes to enhance the program's utility, such as input from patients about temporal changes in their symptoms and technical resources for home monitoring devices.
Background: The use of mobile tools in nursing care is indispensable. Given the importance of nurses' acceptance of these tools in delivering effective care, this issue requires greater attention.
Objective: This study aims to design the Mobile Health Tool Acceptance Scale for Nurses based on the Expectation-Confirmation Theory and to evaluate it psychometrically.
Methods: Using a Waltz-based approach grounded in existing tools and the constructs of the Expectation-Confirmation Theory, the initial version of the scale was designed and evaluated for face and content validity. Construct validity was examined through exploratory factor analysis, concurrent validity, and known-group comparison. Reliability was assessed using measures of internal consistency and stability.
Results: The initial version of the scale consisted of 33 items. During the qualitative and quantitative content validity stage, 1 item was added and 1 item was removed. Exploratory factor analysis, retaining 33 items, identified 5 factors that explained 70.53% of the variance. A significant positive correlation was found between the scores of the designed tool and nurses' attitudes toward using mobile-based apps in nursing care (r=0.655, P<.001). The intraclass correlation coefficient, Cronbach α, and ω coefficient were 0.938, 0.953, and 0.907, respectively.
Conclusions: The 33-item scale developed is a valid and reliable instrument for measuring nurses' acceptance of mobile health tools.
Background: Digitization is vital for data management, especially in health care. However, problems still hinder health care stakeholders in their daily work while collecting, processing, and providing health data or information. Data are missing, incorrect, cannot be collected, or information is inadequately presented. These problems can be seen as data or information problems. A proven way to elicit requirements for (software) systems is by using creative frameworks (eg, user-centered design, design thinking, lean UX [user experience], or service design) or creative methods (eg, mind mapping, storyboarding, 6 thinking hats, or interaction room). However, to what extent they are used to solve data or information-related problems in health care is unclear.
Objective: The primary objective of this scoping review is to investigate the use of creative frameworks in addressing data and information problems in health care.
Methods: Following JBI guidelines and the PRISMA-ScR framework, this paper analyzes selected papers, answering whether creative frameworks addressed health care data or information problems. Focusing on data problems (elicitation or collection, processing) and information problems (provision or visualization), the review examined German and English papers published between 2018 and 2022 using keywords related to "data," "design," and "user-centered." The database SCOPUS was used.
Results: Of the 898 query results, only 23 papers described a data or information problem and a creative method to solve it. These were included in the follow-up analysis and divided into different problem categories: data collection (n=7), data processing (n=1), information visualization (n=11), and mixed problems meaning data and information problem present (n=4). The analysis showed that most identified problems fall into the information visualization category. This could indicate that creative frameworks are particularly suitable for solving information or visualization problems and less for other, more abstract areas such as data problems. The results also showed that most researchers applied a creative framework after they knew what specific (data or information) problem they had (n=21). Only a minority chose a creative framework to identify a problem and realize it was a data or information problem (n=2). In response to these findings, the paper discusses the need for a new approach that addresses health care data and information challenges by promoting collaboration, iterative feedback, and user-centered development.
Conclusions: Although the potential of creative frameworks is undisputed, applying these in solving data and information problems is a minority. To harness this potential, a suitable method needs to be developed to support health care system stakeholders. This method could be the User-Centered Data Approach.
Background: Robotic technologies present challenges to health care professionals and are therefore rarely used. Barriers such as lack of controllability and adaptability and complex control functions affect the human-robot relationship. In addition to educational opportunities, the possibility of individual adaptation can improve the usability and practical implementation of robotics. Previous work has focused on developments from a technology-centered perspective and has included user interests too late in the process.
Objective: This study addresses the following research question: What cocreative research approaches are used in the field of nursing robotics to improve the usability, intended use, and goal-directed application of robotic developments for nurses and to support the nursing process?
Methods: This scoping review provides an overview of the topic and the research activities taking place within it. Five databases and the reference lists of the identified publications were searched for studies without further restrictions. Studies were included if they developed and evaluated interaction and control platforms for robotic systems in health care in a cocreative way with end users.
Results: The search resulted in 419 hits, of which 3 publications were included. All publications were feasibility or user studies that were mainly carried out in the European Union. The 3 interaction and control platforms presented were all prototypes and not commercially available. In addition to those in need of care, all studies also included family carers and health care professionals.
Conclusions: Robotic interaction and control platforms in health care are rarely, if ever, developed and evaluated with feasibility or user studies that include prototypes and end users. While the involvement of end users is crucial, this review emphasizes that all stakeholders, including health care professionals, should participate in the development process to ensure a holistic understanding of application needs and a focus on user experiences and practical health care needs. It is emphasized that the active involvement of end users in the development process is critical to effectively meeting the needs of the target group.
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