JMIR Human Factors最新文献

Background: Web-based mental health forums have the potential to play a significant role in providing accessible support for young people, supplementing in-person services and contributing positively to their mental well-being. However, limited engagement often constrains their impact and effectiveness in supporting young people.

Objective: Using the Behavior Change Wheel framework, this qualitative study explores the barriers and facilitators to young people's engagement with web-based mental health forums, focusing on the behaviors of creating new posts, responding to posts, and reading posts. Behavior change techniques (BCTs) are identified to address these barriers.

Methods: Semistructured interviews were conducted with 13 young people aged 17-25 years who use UK-based youth mental health forums. Three participants self-identified as men, 8 as women, 1 as nonbinary, and 1 chose not to disclose their gender. Transcripts were coded using the Theoretical Domains Framework (TDF), followed by inductive theme generation. TDF barriers were then mapped to BCTs to suggest intervention strategies.

Results: Thematic analysis revealed ten inductive themes across 5 TDF domains. Of these, 3 were enablers, 2 were barriers, and 5 functioned as both enablers and barriers. The findings indicated that skills, beliefs about consequences, emotions, and the social and physical environment are key influences on young people's engagement with web-based mental health forums. Positive emotions experienced after using the forums enabled posting, responding, and reading behaviors. Enablers of more active participation (ie, posting and responding) included anonymity and positive interactions with other users. The presence of moderators acted as an enabler for all 3 behaviors by providing a safe environment, but also as a barrier to posting, as moderation could restrict the content of users' posts. Similarly, mobile access facilitated posting, responding, and reading, whereas layouts not optimized for mobile use acted as barriers to typing and reading on the go.

Conclusions: This study contributes to the existing knowledge base by examining the different ways in which young people engage with youth mental health forums. Different strategies may be prioritized and adopted depending on whether forum providers aim to increase more active forms of engagement (eg, posting and responding, which can be encouraged by fostering positive interactions with other users) or overall engagement (eg, establishing clear rules of engagement and optimizing web page content for mobile access can benefit all forms of engagement). These insights can help improve the delivery of youth mental health forums and foster a positive ecosystem of support for young people.

Background: With the rising global adoption of telemedicine, there is a crucial need to address inefficiencies and challenges in current service systems. This case study focused on enhancing the telemedicine service system of a traditional Chinese medicine clinic.

Objective: The primary objective was to identify and address pain points and inefficiencies in the existing telemedicine system with the aim of streamlining service operations for the benefit of both patients and service providers.

Methods: Through comprehensive service design analysis, including the creation of a customer journey map and a service blueprint, key areas for improvement were identified, and the service process was redesigned accordingly. A user-friendly web application was developed and evaluated using usability testing and satisfaction assessments. Participants took part voluntarily. Task testing was conducted using real-world scenarios, with index of item-objective congruence values ranging from 0.84 to 1.00. Participants were assigned role-specific tasks as either patients or service providers in a step-by-step format, followed by role-specific paper-based questionnaires.

Results: The redesigned system successfully streamlined operations by automating processes and reducing task complexity, resulting in improved time efficiency for both user groups. Participants included 6 patients (aged 23-54 years) and 7 service providers from various departments. Usability testing revealed a task success rate of 100% for all tasks among patients, coordinators, physicians, and finance personnel as well as 83.33% among pharmacists. Satisfaction outcomes were positive: patients reported a net promoter score of 67, whereas service providers reported a mean System Usability Scale score of 71.4 (SD 20.76).

Conclusions: This study highlights the transformative potential of telemedicine in health care delivery. For patients, consolidating services into a single digital platform improved accessibility and ease of use. For service providers, the system reduced repetitive tasks and facilitated more efficient task completion. These findings demonstrate the effectiveness of service design methodologies in enhancing telemedicine systems, ultimately contributing to improved health care quality and patient outcomes.

Background: Attention-deficit/hyperactivity disorder (ADHD) is a prevalent neurodevelopmental disorder affecting 3%-7% of children globally. Alternative treatments are needed to address the limitations of traditional pharmacotherapy and nonpharmacotherapy, such as drug side effects and substantial time and financial costs. In this light, digital therapeutics for childhood ADHD are emerging as an effective alternative, with the benefits of potentially being free from serious side effects associated with software-based treatments and facilitating easy home use without constraints on time or space.

Objective: This study aims to evaluate whether a 4-week digital treatment program can improve symptoms, problem behaviors, and neurocognitive functions in children with ADHD, independent of medication status, while also gauging participant satisfaction with the program.

Methods: We recruited 22 Korean children aged 6-12 years with a diagnosis of ADHD. During the preintervention visit, we collected data on ADHD symptoms, relevant behavior scales, and neurocognitive assessments. Participants then used the program 5 times per day, 5 days a week for 4 weeks at home. At the postintervention visit, we collected the same data as during the preintervention visit and gathered additional feedback on their experience over the 4 weeks.

Results: A total of 19 participants were included in the statistical analysis, showing significant decreases in scores across various categories. These included the Korean ADHD Rating Scale (Total: P=.004; Inattentive: P=.004; and Hyperactive-impulsive: P=.01) and Korean Conners' Parent Rating Scale (Total: P<.001; Impulsive-hyperactive: P=.001; and Conduct Problem I: P=.04). Significant improvements were also noted in the Stroop word (P=.004), color (P<.001), and color-word (P<.001) scores. No significant differences in treatment effects were found between medicated and unmedicated participants. Caregiver and child satisfaction surveys yielded mean ratings of 4.3 and 4.1 out of 5, respectively.

Conclusions: A 4-week gamified intervention improves attention and hyperactivity-impulsivity in children with ADHD, irrespective of medication status, demonstrating its potential effectiveness and acceptability as a treatment option. As this is a small pilot study and underpowered, larger studies with appropriate control groups are needed in future research.

Background: Mass displacement is a grand public health challenge. Refugees and immigrants experience a disparate hypertension burden and disparities in self-management. Successful hypertension self-management is key for improving outcomes, but research on its feasibility in refugee and immigrant health care settings is limited.

Objective: This study aimed to identify clinic staff-perceived barriers to and facilitators of implementing a digital intervention for hypertension self-management among refugee and immigrant patients and to identify its feasibility and usability.

Methods: Primary care physicians and medical assistants who care for refugees and immigrants in San Diego were interviewed using human-centered semistructured methods (n=18). Interviews were analyzed using an inductive approach. Usability testing for the software (Med Pro Care) was conducted with participants (n=15) to test the feasibility of real-time tracking of blood pressure (BP) home readings for hypertension self-management. Clinical staff rated their satisfaction on the System Usability Scale and the NASA Task Load Index, which measured mental workload.

Results: For refugee and immigrant patients self-managing hypertension, clinical staff identified barriers and facilitators in the following areas: (1) social determinants of health increase hypertension burden among refugee and immigrant patients, (2) clinical staff face challenges to effective hypertension care for refugee and immigrant patients, (3) perceived benefits of potential intervention for self-management, and (4) perceived barriers to potential intervention for self-management. Primary care physicians completed 90% of the tasks, and medical assistants completed 83% of the tasks successfully. Most clinic staff found the software system for monitoring BP to be easy to use with an average score for usability of 4.1 of 5.0 (SD 0.4).

Conclusions: Addressing identified barriers to and facilitators of self-management of hypertension is crucial to designing effective interventions in real-world refugee and immigrant health care settings. Telemonitoring interventions using software that transfers BP readings to clinical staff in real time may be feasible from the perspective of clinic staff and can address hypertension disparities in marginalized populations, such as immigrants and refugees. Addressing identified barriers to and facilitators of self-management is crucial to designing effective interventions in real-world refugee and immigrant health care settings. Our findings suggest that clinic staff view digital telemonitoring as both feasible and supportive of patient empowerment, health literacy, and improved communication-factors essential to addressing hypertension disparities in marginalized populations.

Background: Mobile apps are a promising way to improve healthy lifestyle behavior among people with infertility. However, sufficient engagement with mobile health apps is crucial to influence health outcomes, and identifying features to create more effective interventions is urgently needed.

Objective: This study conducted a process evaluation focusing on the use and user experience of the PreLiFe app, a mobile lifestyle app for couples undergoing in vitro fertilization (IVF).

Methods: A mixed methods approach was used among heterosexual couples with infertility undergoing IVF. An objective quantitative study using a tracking-based system assessed the actual use of the PreLiFe app over time in relation to partner use and in relation to the specific fertility treatment. A subjective quantitative study using online questionnaires assessed the acceptability (using the Mobile App Rating Scale) and partner support (based on the Social Support for Diet and Exercise Scale) experienced while using the PreLiFe app. A subjective qualitative study using semistructured interviews evaluated in-depth user experiences with the PreLiFe app.

Results: A total of 106 couples used the PreLiFe app for 2 to 365 days. Overall use was low; 18.9% (20/106) of the men and 49.1% (52/106) of the women used all the modules of the PreLiFe app. Mixed-model analyses revealed that higher app use was observed when a partner used the app as well and during fertility treatment. The average acceptability score was 6 (SD 1) of 10, and patients felt supported by their partners while using the app. Semistructured interviews with 10 patients indicated that the PreLiFe app was easy to use.

Conclusions: Our findings showed good acceptability and user experiences but low actual objective use of a preconception lifestyle app for couples undergoing IVF. To increase use of and engagement with such apps, future studies should further focus on personalization and interaction with partners, health care providers, and other patient data systems.

Background: The aging population presents challenges for healthcare systems. Assistive technologies (ATs) like telemonitoring, fall detection, and self-monitoring devices offer potential solutions to support older adults and their care. However, successful implementation relies on their acceptance, which remains poorly understood, particularly among non-users.

Objective: This study explores older adults' perceptions of ATs, including perceived benefits, adoption barriers, and factors influencing willingness to use these technologies.

Methods: A qualitative study was conducted with 31 participants (aged 65+) with varying levels of health and care needs. Data were collected through six focus groups and six in-depth interviews, then analyzed thematically using NVivo software.

Results: Seven themes emerged: 1) Limited familiarity, with greater recognition of fall detection and self-monitoring devices compared to telemonitoring; 2) Perceived benefits, include safety, independence, and chronic disease management; 3) Key concerns include usability, cost, reliability, privacy, and psychological impacts; 4) Suggested improvements comprise user-friendly designs and training programs; 5) Contextual influences identified with independent older adults perceiving greater utility; 6) Strategies for ATs' promotion proposed such as media campaigns, government subsidies, and healthcare endorsements; and 7) Overall willingness to adopt ATs, driven by perceived need, social and healthcare influence, and ease of use.

Conclusions: While ATs offer clear benefits, adoption remains limited due to usability, cost, and psychological concerns. Improving accessibility, training, and integration into traditional healthcare services delivery may facilitate acceptance and use. Future research should focus on inclusive designs and policy interventions to maximize ATs' potential in aging populations.

Clinicaltrial:

Background: We co-designed the novel multicomponent CAPS (Care Assistant and support Program for people after Stroke or transient ischemic attack) to augment the secondary prevention of stroke.

Objective: Following completion of a feasibility study, we sought feedback from Australian clinicians and service provider representatives (the potential deliverers of CAPS) regarding their perceptions of CAPS for secondary prevention and the pathways to real-world adoption.

Methods: This was a qualitative descriptive study of clinicians and service provider representatives involved in the delivery of stroke care around Australia. A pragmatic convenience sample was obtained by contacting previous CAPS co-design study participants; leveraging professional networks (eg, LinkedIn); and distributing study flyers and newsletters via primary health care networks, general practitioner (GP) networks, and social media posts (Commonwealth Scientific and Industrial Research Organization's LinkedIn pages). Semistructured interviews and focus groups were conducted virtually with clinicians and representatives of the Stroke Foundation (Australia). Qualitative content analysis was undertaken.

Results: Overall, 18 clinicians and 3 Stroke Foundation representatives participated from 5 Australian states, including medical specialists, GPs, nurses, and allied health professionals. We collected their perceptions of CAPS, categorized as potential benefits of the program for secondary prevention, and the considerations for facilitators and challenges to real-world program implementation. The perceived benefits of supporting self-management for patients and facilitating informed decision-making for clinicians were identified. Discussions regarding program implementation included program initiation and duration, patient support considerations, and workflow alignment, which involved consideration of the barriers and enablers to uptake within primary care practice and Stroke Foundation outreach support programs.

Conclusions: There was support from participants for the potential of CAPS to improve the secondary prevention of stroke. However, approaches for addressing the challenges raised by participants, including further implementation and integration considerations, such as sustainability of the model of care, are likely required for CAPS to be successfully embedded within clinical settings.

Background: The collection of dietary behavior data is crucial in childbearing populations. In addition to observed inequities in perinatal dietary intake and quality, burdensome assessment methods (eg, 24-h dietary recall) may limit research participation for some groups. Ecological momentary assessment (EMA) is associated with reduced recall bias and participant convenience, but there is a dearth of studies with diverse cohorts.

Objective: Our aim is to describe participant completion of food intake items in EMA surveys, overall and across individual characteristics (eg, prepregnancy BMI).

Methods: Using secondary EMA data from participants in a longitudinal study, we report average completion rates of survey items regarding dietary behavior (eg, number of meals eaten in a day) across individual demographic variables (eg, age) and combined strata (eg, race+age) during late pregnancy and throughout 12 months post partum.

Results: In our analytic sample (N=310), the average completion rate was 52.4% (SD 27.8%) during pregnancy, rising to 59.1% (SD 22.0%) after giving birth. Participants who were older (>30 y), overweight before pregnancy, self-identified as White, working, or earning higher annual income (>US $50,000) had higher average completion rates than their counterparts. Examining combined strata, we found some variation in survey completion within racial groups. Black participants using a study phone had higher average completion rates during pregnancy and post partum, but this relationship was reversed for White participants.

Conclusions: Our secondary analysis showed relatively stable engagement with EMA surveys in a childbearing cohort across 15 months. Increased completion rates among privileged groups (eg, White, higher income) may demonstrate the impact of socioeconomic advantages on individual health behaviors. Investigators should consider how intersections between race and other factors (eg, employment) may impact participation and data collection.