JMIR Human Factors最新文献

Background: Pain drawing (PD) body charts are widely used in back pain research, but the representation of sex in these charts has not been systematically evaluated.

Objective: This study aims to evaluate sex representation in PD body charts used in back pain research, assess the perception of a newly designed sex-neutral body chart, and explore user preferences for sex representation in PD body charts.

Methods: We conducted a multimethod study comprising: (1) a scoping review to assess sex representation and the reporting of sex in PD body charts in back pain literature, (2) an expert opinion study where anatomy experts evaluated the perceived sex of extracted body charts, and (3) a survey among a representative sample of UK adults with and without back pain to assess the perception of a newly designed sex-neutral body chart and explore preferences for sex representation in PD body charts.

Results: From 349 full-text papers, 108 articles met the inclusion criteria. Most (103/108, 95.4%) did not report the sex of the body charts used, and only 5.6% (6/108) included both male and female charts. Experts showed fair to moderate agreement (Fleiss κ=0.306; Gwet AC1=0.456) in assessing the sex of charts, with most charts assessed as male based on majority ratings (59/108, 54.6%) and classified as male-biased relative to the sex distribution of study participants (76/108, 67.7%). The newly designed sex-neutral body chart was perceived as sex-neutral by 68.5% (204/298) of survey participants across diverse groups. However, perceptions varied by racial group: 73% (181/248) of White participants viewed it as sex-neutral, compared to 42.5% (17/40) of participants from smaller racial groups (χ²2=15.9; P=.001). Female participants slightly preferred female charts (85/154, 55.2%); male participants preferred sex-neutral ones (88/144, 61.1%). Nonetheless, most female participants (82/154, 53.3%) and male participants (107/144, 74.3%) considered the option to choose between male, female, and sex-neutral chart versions unimportant.

Conclusions: Our study reveals reporting gaps and a predominant male bias in the representation of sex in PD body charts used in back pain research. The newly developed sex-neutral body chart was widely perceived as sex-neutral, offering a promising step toward more inclusive pain assessment. However, variations in perception across racial groups highlight the need for cultural considerations in design. These findings underscore the potential of sex-neutral and culturally sensitive body charts to enhance the inclusivity and equity of back pain research and clinical practice.

Background: Early rehabilitation in neurocritical care is often underutilized due to fragmented workflows, interdisciplinary coordination challenges, and the absence of structured digital decision support. Traditional clinical decision support systems (CDSS) often address single domains and lack adaptability to the dynamic, multiprofessional workflows of intensive care units (ICUs).

Objective: To develop and evaluate the usability of the ERATbi App (Early Recovery After Traumatic Brain Injury App), a modular, tablet-based CDSS was designed to streamline early rehabilitation planning and strengthen interdisciplinary coordination for patients with moderate-to-severe traumatic brain injury (TBI) in intensive care settings.

Methods: The ERATbi app integrates four functional modules-delirium risk management, precision nutrition, stepwise early mobilization, and respiratory care for rib fractures-into a unified interface. A simulation-based usability study was conducted with 18 ICU clinicians. Evaluation metrics included System Usability Scale (SUS) scores, task completion rates, error rates, and task durations. Additional user feedback was collected via a 5-point Likert satisfaction survey and semi-structured qualitative interviews.

Results: The app demonstrated high usability (mean SUS score 83.6, SD 7.4), a 100% (18/18 participants) task completion rate, and a low error rate (4.2%). Average module completion time was 6.5 minutes, and user satisfaction was high (mean 4.7, SD 0.5). Users highlighted the value of the app's visual logic, real-time alerts, adaptive thresholds, and modular workflow integration for enhancing team coordination and decision consistency.

Conclusions: The ERATbi app demonstrated excellent usability, high user satisfaction, and clinical relevance in simulated ICU workflows. Its logic-driven, workflow- integrated design may support scalable, interdisciplinary implementation of early rehabilitation in neurocritical care settings.

Background: Human factors (HF), or ergonomics, which explores the interaction between humans and systems, has been used to support design in safety-critical industries such as aviation, transportation, nuclear power, and manufacturing. HF methods have the potential to support the safe design of health IT; however, the evaluation of HF methods to determine their effectiveness and feasibility in this context has been limited.

Objective: The aim of this study was to identify criteria for evaluating HF methods when applied to real-world projects and to use these to propose a framework for method evaluation.

Methods: The study design was qualitative and descriptive and involved semistructured interviews with HF experts working across health and nonhealth industries in academic and/or practitioner roles. HF experts held a relevant degree (eg, ergonomics and HF engineering) and were actively using their HF expertise. Results were thematically analyzed.

Results: A total of 21 participants took part, and interviews lasted, on average, 52 (range 39-103) minutes. Participants mentioned that they did not routinely evaluate methods; however, when asked how they would evaluate methods, they outlined a range of criteria to support method evaluation. Overall, 5 criteria and 28 subcriteria were identified. High-level criteria included effectiveness, efficiency, ease of use and acceptability, and impact on the solution.

Conclusions: Results from this study were used to propose a framework for evaluating HF methods used in real-world health IT projects. The framework should provide organizations with valuable information on how to optimize the application and outcomes of HF methods and build HF capability within organizations, particularly where this capability may be lacking.

Background: Irritable bowel syndrome (IBS) is a common chronic gastrointestinal disorder that impairs bowel functions and patients' overall quality of life. IBS-focused digital health technologies (DHTs), including online health resources and mobile health (mHealth) apps, have recently proliferated for patient use. However, research exploring patients' experiences with navigating, adopting, or using commercial or publicly available DHTs for IBS self-management is limited.

Objective: This study aims to explore the user experiences and decision-making of patients with IBS as they navigate, adopt, and use diverse DHTs for disease self-management.

Methods: We conducted virtual semistructured focus group interviews to explore the experiences of patients with IBS using DHTs, including their perspectives on design and features, their decision-making process in using DHTs, and recommendations for improving user experience and uptake, given the heterogeneous nature of these tools. Canada-based patients with IBS who were using or had used mHealth apps to manage symptoms were recruited through purposive sampling from previous IBS-related studies. Discussions were transcribed verbatim, and inductive thematic analysis was performed using NVivo (version 14; Lumivero). A modified version of the Expanded Unified Theory of Acceptance and Use of Technology (UTAUT2) model was applied to guide the interpretation of the dynamic relationship between the influences on participants' decisions regarding DHT use.

Results: Among the 8 participants (all female; mean age 55.3, SD 13.5 years), two themes were identified: (1) uncertainty impacts the trustworthiness of DHTs, and (2) influences that drive the decision-making process to adopt and use DHTs. The observed influences aligned with the constructs of the UTAUT2 model (performance expectancy, effort expectancy, social influence, facilitating conditions, hedonic motivation, price value, and habit), with the addition of trust and risk in participants' decision-making. Digital health literacy and patient engagement were also raised as crucial components of participants' experiences and perspectives on DHTs.

Conclusions: Findings of this study highlight the current landscape of digital health in IBS and existing gaps and challenges for patients in navigating, adopting, and using DHTs for IBS self-management. While DHTs were generally viewed positively for their value and potential, patients with IBS consider several coexisting factors and trade-offs in their decision-making. Further investigations on the influences on and perspectives toward DHTs could enhance future development and iterations of these tools and improve patient confidence and uptake.

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: 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: 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: 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.