JMIR Human Factors最新文献

Background: Health care institutions face high systemic risk due to the inherent uncertainty and complexity of their operations. This often leads to stressful incidents impacting the well-being of health care professionals, which can compromise the effectiveness of health care systems. Enhancing resilience among health care professionals is essential for maintaining high-quality care and ensuring patient safety. The role of middle managers is essential to ensure the response capacity of individuals and teams.

Objective: This study aims to develop a web-based intervention aimed at middle management to enhance individual, team, and organizational resilience.

Methods: An observational study was conducted in 3 phases: design, validation, and pilot study. The study was initiated in February 2022 and concluded in June 2023. Phase 1 involved designing the content for the web-based tool based on a comprehensive review of critical elements around resilience. Phase 2 included validation by an international panel of experts who reviewed the tool and rated it according to a structured grid. They were also encouraged to highlight strengths and areas for improvement. Phase 3 involved piloting the tool with health care professionals in Ecuador to refine the platform and assess its effectiveness. A total of 458 people were invited to participate through the Institutional Course on Continuous Improvement in Health Care Quality and Safety offered by the Ministry of Public Health of Ecuador.

Results: The tool, eResiliencia, was structured into 2 main blocks: individual and team resilience and organizational resilience. It included videos, images, PDFs, and links to dynamic graphics and additional texts. Furthermore, 13 (65%) of the 20 experts validated the tool, rating content clarity at an average of 4.5 (SD 0.7) and utility at an average of 4.7 (SD 0.5) out of 5. The average overall satisfaction was 9.3 (SD 0.6) out of 10 points, and feedback on improvements was implemented. A total of 362 health care professionals began the intervention, of which 218 (60.2%) completed preintervention and postintervention questionnaires, with significant knowledge increases (P<.001). Of the 362 health care professionals, 146 (40.3%) completed the satisfaction questionnaire, where overall satisfaction was rated at an average of 9.4 (SD 1.1) out of 10 points.

Conclusions: The eResiliencia web-based platform provides middle managers with resources to enhance resilience among their teams and their components, promoting better well-being and performance, even under highly stressful events. Future research should focus on long-term impacts and practical applications in diverse clinical settings.

Background: Increasing use of computational methods in health care provides opportunities to address previously unsolvable problems. Machine learning techniques applied to routinely collected data can enhance clinical tools and improve patient outcomes, but their effective deployment comes with significant challenges. While some tasks can be addressed by training machine learning models directly on the collected data, more complex problems require additional input in the form of data annotations. Data annotation is a complex and time-consuming problem that requires domain expertise and frequently, technical proficiency. With clinicians' time being an extremely limited resource, existing tools fail to provide an effective workflow for deployment in health care.

Objective: This paper investigates the approach of intensive care unit staff to the task of data annotation. Specifically, it aims to (1) understand how clinicians approach data annotation and (2) capture the requirements for a digital annotation tool for the health care setting.

Methods: We conducted an experimental activity involving annotation of the printed excerpts of real time-series admission data with 7 intensive care unit clinicians. Each participant annotated an identical set of admissions with the periods of weaning from mechanical ventilation during a single 45-minute workshop. Participants were observed during task completion and their actions were analyzed within Norman's Interaction Cycle model to identify the software requirements.

Results: Clinicians followed a cyclic process of investigation, annotation, data reevaluation, and label refinement. Variety of techniques were used to investigate data and create annotations. We identified 11 requirements for the digital tool across 4 domains: annotation of individual admissions (n=5), semiautomated annotation (n=3), operational constraints (n=2), and use of labels in machine learning (n=1).

Conclusions: Effective data annotation in a clinical setting relies on flexibility in analysis and label creation and workflow continuity across multiple admissions. There is a need to ensure a seamless transition between data investigation, annotation, and refinement of the labels.

Background: Peer support groups or web-based chats for young people offer anonymous peer support in judgment-free spaces, where users may share their thoughts and feelings with others who may have experienced similar situations. User engagement is crucial for effective web-based peer support; however, levels of engagement vary. While moderation of peer support groups can have a positive impact on the engagement of young people, effective moderation can be challenging to implement.

Objective: This study aimed to identify barriers and facilitators to user engagement with, and moderation of, web-based peer support groups among young people aged 16 to 25 years and to provide recommendations for enhancing this service.

Methods: Drawing upon the Theoretical Domains Framework (TDF) and the Behavior Change Wheel (BCW), this study conducted qualitative interviews and gathered open-ended questionnaires from service users and moderators of The Mix, the United Kingdom's leading web-based mental health platform providing peer support groups for young people. Semistructured interviews were conducted with 2 service users and 8 moderators, and open-ended questionnaires were completed by 7 service users. Themes were coded using the Capability, Opportunity, Motivation, and Behavior (COM-B) model and the TDF. The BCW tools were then used to identify relevant behavior change techniques to improve user engagement in, and moderation of, the service.

Results: Thematic analysis revealed a total of 20 inductive themes within 10 TDF domains-9 (45%) for engagement and 11 (55%) for moderation. Of these 20 themes, 3 (15%) were facilitators of engagement, 7 (35%) were facilitators of moderation, 4 (20%) were barriers to moderation, and 6 (30%) barriers to engagement. Results suggest that skills, knowledge, beliefs about consequences, intentions, emotions, and the social and physical environment are important factors influencing service users and moderators of group chats. In particular, supporting the improvement of memory, attention, and decision-making skills of those involved; adapting the physical environment to facilitate effective interactions; and reducing negative emotions are suggested to optimize the value and effectiveness of peer support groups for young people's mental health for both the service users and moderators of these services.

Conclusions: The study demonstrates the effectiveness of the BCW approach and the use of the TDF and COM-B model to understand the influences on behavior in a systematic manner, especially for mental health and well-being interventions. The findings can be applied to design structured interventions to change behaviors related to the engagement with, and moderation of, web-based peer support groups and, in turn, improve mental health outcomes for young people.

Background: The rapid advancement of telehealth has led to the emergence of avatar-based psychotherapy (ABP), which combines the benefits of anonymity with nonverbal communication. With the adoption of remote mental health services, understanding the efficacy and user experience of ABP has become increasingly important.

Objective: This study aimed to explore the user experience and therapeutic relationship formation in short-term ABP environments, focusing on psychological effects, user satisfaction, and critical factors for implementation.

Methods: This qualitative study involved 18 adult participants (8 women and 10 men). Participants engaged in two short-term ABP sessions (approximately 50 minutes per session) over 2 weeks, using an ABP metaverse system prototype. Semistructured in-depth interviews were conducted with both the participants and therapists before and after the ABP sessions. The interviews were conducted via an online platform, with each interview lasting approximately 30 minutes. The key topics included the sense of intimacy, communication effectiveness of avatar expressions, emotions toward one's avatar, concentration during sessions, and perceived important aspects of the ABP. Data were analyzed using thematic analysis.

Results: The analysis revealed 3 main themes with 8 subthemes: (1) reduction of psychological barriers through avatar use (subthemes: anonymity, ease of access, self-objectification, and potential for self-disclosure); (2) importance of the avatar-self-connection in therapeutic relationship formation (subthemes: avatar self-relevance and avatar-self-connection fostering intimacy and trust); and (3) importance of nonverbal communication (subthemes: significance of nonverbal expressions and formation of empathy and trust through nonverbal expressions). Participants reported enhanced comfort and self-disclosure owing to the anonymity provided by avatars, while emphasizing the importance of avatar customization and the role of nonverbal cues in facilitating communication and building rapport.

Conclusions: This pilot study provides valuable insights into the short-term ABP user experience and therapeutic relationship formation. Our findings suggest that ABP has the potential to reduce barriers to therapy through anonymity, ease of access, and potential for self-disclosure, while allowing for meaningful nonverbal communication. The avatar-self-connection emerged as a crucial factor in the effectiveness of ABP, highlighting the importance of avatar customization in enhancing user engagement and therapeutic outcomes. Future research and development in ABP should focus on improving avatar customization options, enhancing the fidelity of nonverbal cues, and investigating the long-term effectiveness of ABP compared with traditional face-to-face therapy.

Background: Problem gambling and gambling disorder cause severe social, psychiatric, and financial consequences, and voluntary self-exclusion is a common harm reduction tool used by individuals with gambling problems.

Objective: The aim of this study was to explore users' experience of a novel nationwide, multioperator gambling self-exclusion service, "Spelpaus," in Sweden and to inform stakeholders and policy makers in order to improve harm reduction tools against gambling problems.

Methods: Semistructured interviews were conducted with 15 individuals who reported self-perceived gambling problems and who had experience of having used the self-exclusion service Spelpaus in Sweden. Interviews were transcribed and analyzed through qualitative content analysis.

Results: We identified 3 categories and 8 subcategories. The categories were (1) reasons for the decision to self-exclude, (2) positive experiences, and (3) suggestions for improvement. The subcategories identified a number of reasons for self-exclusion, such as financial reasons and family reasons, and positive experiences described as a relief from gambling; in addition, important suggestions for improvement were cited, such as a more gradual return to gambling post-self-exclusion, better ways to address loopholes in the system, and transfer from self-exclusion to treatment.

Conclusions: Voluntary self-exclusion from gambling, using a nationwide multioperator service, remains an appreciated harm-reducing tool. However, transfer from self-exclusion to treatment should be facilitated by policy making, and loopholes allowing for breaching of the self-exclusion need to be counteracted.

Background: Digital health innovations provide an opportunity to improve access to care, information, and quality of care during the perinatal period, a critical period of health for mothers and infants. However, research to develop perinatal digital health solutions needs to be informed by actual patient and health system needs in order to optimize implementation, adoption, and sustainability.

Objective: Our aim was to co-design a research agenda with defined research priorities that reflected health system realities and patient needs.

Methods: Co-design of the research agenda involved a series of activities: (1) review of the provincial Digital Health Strategy and Maternity Services Strategy to identify relevant health system priorities, (2) anonymous survey targeting perinatal care providers to ascertain their current use and perceived need for digital tools, (3) engagement meetings using human-centered design methods with multilingual patients who are currently or recently pregnant to understand their health experiences and needs, and (4) a workshop that brought together patients and other project partners to prioritize identified challenges and opportunities for perinatal digital health in a set of research questions. These questions were grouped into themes using a deductive analysis approach starting with current BC Digital Health Strategy guiding principles.

Results: Between September 15, 2022, and August 31, 2023, we engaged with more than 150 perinatal health care providers, researchers, and health system stakeholders and a patient advisory group of women who were recently pregnant to understand the perceived needs and priorities for digital innovation in perinatal care in British Columbia, Canada. As a combined group, partners were able to define 12 priority research questions in 3 themes. The themes prioritized are digital innovation for (1) patient autonomy and support, (2) standardized educational resources for patients and providers, and (3) improved access to health information.

Conclusions: Our research agenda highlights the needs for perinatal digital health research to support improvements in the quality of care in British Columbia. By using a human-centered design approach, we were able to co-design research priorities that are meaningful to patients and health system stakeholders. The identified priority research questions are merely a stepping stone in the research process and now need to be actioned by research teams and health systems partners.

Background: Evaluating digital health service delivery in primary health care requires a validated questionnaire to comprehensively assess users' ability to implement tasks customized to the program's needs.

Objective: This study aimed to develop, test the reliability of, and validate the Tele-Primary Care Oral Health Clinical Information System (TPC-OHCIS) questionnaire for evaluating the implementation of maternal and child digital health information systems.

Methods: A cross-sectional study was conducted in 2 phases. The first phase focused on content item development and was validated by a group of 10 experts using the content validity index. The second phase was to assess its psychometric testing for reliability and validity.

Results: A structured questionnaire of 65 items was constructed to assess the TPC-OHCIS delivery for primary health care use based on literature and has been validated by 10 experts, and 319 respondents answered the 65-item TPC-OHCIS questionnaire, with mean item scores ranging from 1.99 (SD 0.67) to 2.85 (SD 1.019). The content validity, reliability, and face validity showed a scale-level content validity index of 0.90, scale-level content validation ratio of 0.90, and item-level face validity index of 0.76, respectively. The internal reliability was calculated as a Cronbach α value of 0.90, with an intraclass correlation coefficient of 0.91. Scales were determined by the scree plot with eigenvalues >1, and 13 subscales were identified based on principal component analysis. The Kaiser-Meyer-Olkin value was 0.90 (P<.049). The total variance explained was 76.07%, and factor loading scores for all variables were >0.7. The Bartlett test of sphericity, determining construct validity, was found to be significant (P<.049).

Conclusions: The TPC-OHCIS questionnaire is valid to be used at the primary health care level to evaluate the TPC-OHCIS implementation. It can assess health care workers' work performance and job acceptance and improve the quality of care.