Applying User-Centered Design to Develop an Audit and Feedback Intervention for the Home Care Sector

The objective of this study was to optimize a planned audit and feedback (A&F) intervention for home and community care through incorporating user-centered design principles. Phase 1 comprised the development of a paper prototype, followed by testing of the prototype using semistructured interviews and focus groups. Phase 2 involved the development of a revised and online prototype based on the results of Phase 1, followed by user testing. A total of 39 participants across Phase 1 ( n = 33) and Phase 2 ( n = 6) provided input into the design of the A&F intervention. Key changes included improving clarity of the variables, reducing cognitive load, and highlighting opportunities for action. Preliminary findings suggest potential usefulness in this approach to optimize home care management.

Download Full-text

MyPath to Home Web-Based Application for the Geriatric Rehabilitation Program at Bruyère Continuing Care: User-Centered Design and Feasibility Testing Study (Preprint)

10.2196/preprints.18169 ◽

2020 ◽

Author(s):

Chantal Backman ◽

Anne Harley ◽

Craig Kuziemsky ◽

Jay Mercer ◽

Liam Peyton

Keyword(s):

Phase 1 ◽

Health Care Team ◽

Rehabilitation Program ◽

Geriatric Rehabilitation ◽

Phase 2 ◽

User Centered Design ◽

Web Based ◽

Semistructured Interviews ◽

User Centered

BACKGROUND When older adults return home from geriatric rehabilitation in a hospital, remembering the plethora of medical advice and medical instructions provided can be overwhelming for them and for their caregivers. OBJECTIVE The overall objective was to develop and test the feasibility of a novel web-based application called MyPath to Home that can be used to manage the personalized needs of geriatric rehabilitation patients during their transition from the hospital to home. METHODS This study involved (1) co-designing a patient- and clinician-tailored web-based application and (2) testing the feasibility of the application to manage the needs of geriatric rehabilitation patients when leaving the hospital. In phase 1, we followed a user-centered design process integrated with the modern agile software development methodology to iteratively co-design the application. The approach consisted of three cycles in which we engaged patients, caregivers, and clinicians to design a series of prototypes (cycles 1-3). In phase 2, we conducted a single-arm feasibility pilot test of MyPath to Home. Baseline and follow-up surveys, as well as select semistructured interviews were conducted. RESULTS In phase 1, semistructured interviews and talk-aloud sessions were conducted with patients/caregivers (n=5) and clinicians (n=17) to design the application. In phase 2, patients (n=30), caregivers (n=18), and clinicians (n=20) received access to use the application. Patients and their caregivers were asked to complete baseline and follow-up surveys. A total of 91% (21/23) of patients would recommend this application to other patients. In addition, clinicians (n=6) and patients/caregivers (n=6) were interviewed to obtain further details on the value of the web-based application with respect to engaging patients and facilitating communication and sharing of information with the health care team. CONCLUSIONS We were successful at designing the MyPath to Home prototype for patients and their caregivers to engage with their clinicians during the transition from geriatric rehabilitation to home. Further work is needed to increase the uptake and usage by clinicians, and determine if this translates to meaningful changes in clinical and functional outcomes. INTERNATIONAL REGISTERED REPORT RR2-10.2196/11031

Download Full-text

MyPath to Home Web-Based Application for the Geriatric Rehabilitation Program at Bruyère Continuing Care: User-Centered Design and Feasibility Testing Study

JMIR Formative Research ◽

10.2196/18169 ◽

2020 ◽

Vol 4 (9) ◽

pp. e18169

Author(s):

Chantal Backman ◽

Anne Harley ◽

Craig Kuziemsky ◽

Jay Mercer ◽

Liam Peyton

Keyword(s):

Phase 1 ◽

Health Care Team ◽

Rehabilitation Program ◽

Geriatric Rehabilitation ◽

Phase 2 ◽

User Centered Design ◽

Web Based ◽

Semistructured Interviews ◽

User Centered

Background When older adults return home from geriatric rehabilitation in a hospital, remembering the plethora of medical advice and medical instructions provided can be overwhelming for them and for their caregivers. Objective The overall objective was to develop and test the feasibility of a novel web-based application called MyPath to Home that can be used to manage the personalized needs of geriatric rehabilitation patients during their transition from the hospital to home. Methods This study involved (1) co-designing a patient- and clinician-tailored web-based application and (2) testing the feasibility of the application to manage the needs of geriatric rehabilitation patients when leaving the hospital. In phase 1, we followed a user-centered design process integrated with the modern agile software development methodology to iteratively co-design the application. The approach consisted of three cycles in which we engaged patients, caregivers, and clinicians to design a series of prototypes (cycles 1-3). In phase 2, we conducted a single-arm feasibility pilot test of MyPath to Home. Baseline and follow-up surveys, as well as select semistructured interviews were conducted. Results In phase 1, semistructured interviews and talk-aloud sessions were conducted with patients/caregivers (n=5) and clinicians (n=17) to design the application. In phase 2, patients (n=30), caregivers (n=18), and clinicians (n=20) received access to use the application. Patients and their caregivers were asked to complete baseline and follow-up surveys. A total of 91% (21/23) of patients would recommend this application to other patients. In addition, clinicians (n=6) and patients/caregivers (n=6) were interviewed to obtain further details on the value of the web-based application with respect to engaging patients and facilitating communication and sharing of information with the health care team. Conclusions We were successful at designing the MyPath to Home prototype for patients and their caregivers to engage with their clinicians during the transition from geriatric rehabilitation to home. Further work is needed to increase the uptake and usage by clinicians, and determine if this translates to meaningful changes in clinical and functional outcomes. International Registered Report Identifier (IRRID) RR2-10.2196/11031

Download Full-text

Developing Strategies to Reduce Unnecessary Services in Primary Care: Protocol for User-Centered Design Charrettes (Preprint)

10.2196/preprints.15618 ◽

2019 ◽

Author(s):

Mandi L Klamerus ◽

Laura J Damschroder ◽

Jordan B Sparks ◽

Sarah E Skurla ◽

Eve A Kerr ◽

...

Keyword(s):

Primary Care ◽

Design Process ◽

Phase 1 ◽

Primary Care Providers ◽

Medical Services ◽

Second Phase ◽

Phase 2 ◽

User Centered Design ◽

The Impact ◽

User Centered

BACKGROUND Overtreatment and overtesting expose patients to unnecessary, wasteful, and potentially harmful care. Reducing overtreatment or overtesting that has become ingrained in current clinical practices and is being delivered on a routine basis will require solutions that incorporate a deep understanding of multiple perspectives, particularly those on the front lines of clinical care: patients and their clinicians. Design approaches are a promising and innovative way to incorporate stakeholder needs, desires, and challenges to develop solutions to complex problems. OBJECTIVE This study aimed (1) to engage patients in a design process to develop high-level deintensification strategies for primary care (ie, strategies for scaling back or stopping routine medical services that more recent evidence reveals are not beneficial) and (2) to engage both patients and primary care providers in further co-design to develop and refine the broad deintensification strategies identified in phase 1. METHODS We engaged stakeholders in design charrettes—intensive workshops in which key stakeholders are brought together to develop creative solutions to a specific problem—focused on deintensification of routine overuse in primary care. We conducted the study in 2 phases: a 6.5-hour design charrette with 2 different groups of patients (phase 1) and a subsequent 4-hour charrette with clinicians and a subgroup of phase 1 patients (phase 2). Both phases included surveys and educational presentations related to deintensification. Phase 1 involved several design activities (mind mapping, business origami, and empathy mapping) to help patients gain a deeper understanding of the individuals involved in deintensification. Following that, we asked participants to review hypothetical scenarios where patients, clinicians, or the broader health system context posed a barrier to deintensification and then to brainstorm solutions. The deintensification themes identified in phase 1 were used to guide phase 2. This second phase primarily involved 1 design activity (<italic>WhoDo</italic>). In this activity, patients and clinicians worked together to develop concrete actions that specific stakeholders could take to support deintensification efforts. This activity included identifying barriers to the actions and approaches to overcoming those barriers. RESULTS A total of 35 patients participated in phase 1, and 9 patients and 7 clinicians participated in phase 2. The analysis of the deintensification strategies and survey data is currently underway. The results are expected to be submitted for publication in early 2020. CONCLUSIONS Health care interventions are frequently developed without input from the people who are most affected. The exclusion of these stakeholders in the design process often influences and limits the impact of the intervention. This study employed design charrettes, guided by a flexible user-centered design model, to bring clinicians and patients with differing backgrounds and with different expectations together to cocreate real-world solutions to the complex issue of deintensifying medical services.

Download Full-text

Developing Strategies to Reduce Unnecessary Services in Primary Care: Protocol for User-Centered Design Charrettes

JMIR Research Protocols ◽

10.2196/15618 ◽

2019 ◽

Vol 8 (11) ◽

pp. e15618 ◽

Cited By ~ 2

Author(s):

Mandi L Klamerus ◽

Laura J Damschroder ◽

Jordan B Sparks ◽

Sarah E Skurla ◽

Eve A Kerr ◽

...

Keyword(s):

Primary Care ◽

Design Process ◽

Phase 1 ◽

Primary Care Providers ◽

Medical Services ◽

Second Phase ◽

Phase 2 ◽

User Centered Design ◽

The Impact ◽

User Centered

Background Overtreatment and overtesting expose patients to unnecessary, wasteful, and potentially harmful care. Reducing overtreatment or overtesting that has become ingrained in current clinical practices and is being delivered on a routine basis will require solutions that incorporate a deep understanding of multiple perspectives, particularly those on the front lines of clinical care: patients and their clinicians. Design approaches are a promising and innovative way to incorporate stakeholder needs, desires, and challenges to develop solutions to complex problems. Objective This study aimed (1) to engage patients in a design process to develop high-level deintensification strategies for primary care (ie, strategies for scaling back or stopping routine medical services that more recent evidence reveals are not beneficial) and (2) to engage both patients and primary care providers in further co-design to develop and refine the broad deintensification strategies identified in phase 1. Methods We engaged stakeholders in design charrettes—intensive workshops in which key stakeholders are brought together to develop creative solutions to a specific problem—focused on deintensification of routine overuse in primary care. We conducted the study in 2 phases: a 6.5-hour design charrette with 2 different groups of patients (phase 1) and a subsequent 4-hour charrette with clinicians and a subgroup of phase 1 patients (phase 2). Both phases included surveys and educational presentations related to deintensification. Phase 1 involved several design activities (mind mapping, business origami, and empathy mapping) to help patients gain a deeper understanding of the individuals involved in deintensification. Following that, we asked participants to review hypothetical scenarios where patients, clinicians, or the broader health system context posed a barrier to deintensification and then to brainstorm solutions. The deintensification themes identified in phase 1 were used to guide phase 2. This second phase primarily involved 1 design activity (WhoDo). In this activity, patients and clinicians worked together to develop concrete actions that specific stakeholders could take to support deintensification efforts. This activity included identifying barriers to the actions and approaches to overcoming those barriers. Results A total of 35 patients participated in phase 1, and 9 patients and 7 clinicians participated in phase 2. The analysis of the deintensification strategies and survey data is currently underway. The results are expected to be submitted for publication in early 2020. Conclusions Health care interventions are frequently developed without input from the people who are most affected. The exclusion of these stakeholders in the design process often influences and limits the impact of the intervention. This study employed design charrettes, guided by a flexible user-centered design model, to bring clinicians and patients with differing backgrounds and with different expectations together to cocreate real-world solutions to the complex issue of deintensifying medical services. International Registered Report Identifier (IRRID) RR1-10.2196/15618

Download Full-text

A Novel Approach to Practice-Based Learning and Improvement Using a Web-Based Audit and Feedback Module

Journal of Graduate Medical Education ◽

10.4300/jgme-d-14-00016.1 ◽

2014 ◽

Vol 6 (3) ◽

pp. 541-546 ◽

Cited By ~ 4

Author(s):

Joel C. Boggan ◽

George Cheely ◽

Bimal R. Shah ◽

Randy Heffelfinger ◽

Deanna Springall ◽

...

Keyword(s):

Phase 1 ◽

Data Entry ◽

Audit And Feedback ◽

Phase 2 ◽

Online Data ◽

Web Based ◽

Online Tool ◽

Novel Approach ◽

Patients With Diabetes ◽

Personal Performance

Abstract Background Systematically engaging residents in large programs in quality improvement (QI) is challenging. Objective To coordinate a shared QI project in a large residency program using an online tool. Methods A web-based QI tool guided residents through a 2-phase evaluation of performance of foot examinations in patients with diabetes. In phase 1, residents completed reviews of health records with online data entry. Residents were then presented with personal performance data relative to peers and were prompted to develop improvement plans. In phase 2, residents again reviewed personal performance. Rates of performance were compared at the program and clinic levels for each phase, with data presented for residents. Acceptability was measured by the number of residents completing each phase. Feasibility was measured by estimated faculty, programmer, and administrator time and costs. Results Seventy-nine of 86 eligible residents (92%) completed improvement plans and reviewed 1471 patients in phase 1, whereas 68 residents (79%) reviewed 1054 patient charts in phase 2. Rates of performance of examination increased significantly between phases (from 52% to 73% for complete examination, P < .001). Development of the tool required 130 hours of programmer time. Project analysis and management required 6 hours of administrator and faculty time monthly. Conclusions An online tool developed and implemented for program-wide QI initiatives successfully engaged residents to participate in QI activities. Residents using this tool demonstrated improvement in a selected quality target. This tool could be adapted by other graduate medical education programs or for faculty development.

Download Full-text

Using Operational Scenarios in a Virtual Reality Enhanced Design Process

Education Sciences ◽

10.3390/educsci11080448 ◽

2021 ◽

Vol 11 (8) ◽

pp. 448

Author(s):

Katie Aylward ◽

Joakim Dahlman ◽

Kjetil Nordby ◽

Monica Lundh

Keyword(s):

Virtual Reality ◽

Design Process ◽

User Interfaces ◽

End Users ◽

Concept Development ◽

User Centered Design ◽

User Testing ◽

Training And Education ◽

Design Processes ◽

User Centered

Maritime user interfaces for ships’ bridges are highly dependent on the context in which they are used, and rich maritime context is difficult to recreate in the early stages of user-centered design processes. Operations in Arctic waters where crews are faced with extreme environmental conditions, technology limitations and a lack of accurate navigational information further increase this challenge. There is a lack of research supporting the user-centered design of workplaces for hazardous Arctic operations. To meet this challenge, this paper reports on the process of developing virtual reality-reconstructed operational scenarios to connect stakeholders, end-users, designers, and human factors specialists in a joint process. This paper explores how virtual reality-reconstructed operational scenarios can be used as a tool both for concept development and user testing. Three operational scenarios were developed, implemented in a full mission bridge simulator, recreated in virtual reality (VR), and finally tested on navigators (end-users). Qualitative data were captured throughout the design process and user-testing, resulting in a thematic analysis that identified common themes reflecting the experiences gained throughout this process. In conclusion, we argue that operational scenarios, rendered in immersive media such as VR, may be an important and reusable asset when supporting maritime design processes and in maritime training and education.

Download Full-text

Gastrointestinal Symptoms in Children With Life-Limiting Conditions Receiving Palliative Home Care

Frontiers in Pediatrics ◽

10.3389/fped.2021.654531 ◽

2021 ◽

Vol 9 ◽

Author(s):

Holger Hauch ◽

Peter Kriwy ◽

Andreas Hahn ◽

Reinhard Dettmeyer ◽

Klaus-Peter Zimmer ◽

...

Keyword(s):

Palliative Care ◽

Home Care ◽

Phase 1 ◽

Gastrointestinal Symptoms ◽

Phase 2 ◽

Palliative Home Care ◽

Asymptomatic Children ◽

Number Of Patients ◽

Gi Symptoms ◽

At Home

Context: Children with life-limiting diseases suffer from gastrointestinal (GI) symptoms. Since the introduction of specialized palliative home care (SPHC) in Germany, it is possible to care for these children at home. In phase 1 of care the aim is to stabilize the patient. In phase 2, terminal support is provided.Objectives: Analysis were performed of the differences between these phases. The causes and modalities/outcome of treatment were evaluated.Methods: A retrospective study was performed from 2014 to 2020. All home visits were analyzed with regard to the abovementioned symptoms, their causes, treatment and results.Results: In total, 149 children were included (45.9% female, mean age 8.17 ± 7.67 years), and 126 patients were evaluated. GI symptoms were common in both phases. Vomiting was more common in phase 2 (59.3 vs. 27.1%; p < 0.001). After therapy, the proportion of asymptomatic children in phase 1 increased from 40.1 to 75.7%; (p < 0.001). Constipation was present in 52.3% (phase 1) and 54.1% (phase 2). After treatment, the proportion of asymptomatic patients increased from 47.3 to 75.7% in phase 1 (p < 0.001), and grade 3 constipation was reduced from 33.9 to 15% in phase 2 (p < 0.05).Conclusion: Painful GI symptoms occur in both palliative care phases but are more common in phase 2. The severity and frequency can usually be controlled at home. The study limitations were the retrospective design and small number of patients, but the study had a representative population, good data quality and a unique perspective on the reality of outpatient pediatric palliative care in Germany.

Download Full-text

Towards a Behaviour Theory Informed and User-Centred Mobile App for Parents to Prevent Infant Falls (Preprint)

10.2196/preprints.29731 ◽

2021 ◽

Author(s):

Nipuna Cooray ◽

Si Sun ◽

Catherine Ho ◽

Susan Adams ◽

Lisa Keay ◽

...

Keyword(s):

Injury Prevention ◽

Behaviour Change ◽

Phase 1 ◽

Mobile App ◽

Successful Implementation ◽

Think Aloud ◽

Phase 2 ◽

User Testing ◽

Behaviour Change Wheel ◽

Digital Intervention

BACKGROUND Falls account for ~50% of infant injury hospitalisations and caretaker behaviour is central to preventing infant falls. Behaviour theory informed interventions for injury prevention have been suggested, but to date few have been reported. The potential of using smartphones for injury prevention intervention delivery is also under exploited. OBJECTIVE This study aims to develop a behaviour theory, evidence and user centered digital intervention as a mobile app for parents to prevent infant falls following agile development practices. METHODS Infant falls while feeding was selected as the fall mechanism to demonstrate the approach being taken to develop this intervention. In Phase 1, the Behaviour Change Wheel was used as a theoretical framework supported by a literature review to define intervention components which were then implemented as a mobile application. In phase 2 following the person-based approach, user testing via think aloud interviews and comprehension assessments were used to refine content and implementation of the intervention. RESULTS Target behaviours identified in Phase 1 were adequate rest for the newborns mother and safe feeding practices defined as Prepare, Position and Place. From behavioural determinants and the Behaviour Change Wheel, behavior change functions selected to achieve these target behaviours were psychological capability, social opportunity and reflective motivation. Selected Behaviour Change Techniques aligned with these functions were providing information on health consequence, using a credible source, instruction on performing each behaviour and social support. The defined intervention was implemented in a draft Android application. In phase 2, four rounds of user testing were required to achieve the pre-defined target comprehension level. Results from think aloud interviews id were used to refine intervention content and application features. Overall, results from Phase 2 revealed users found the information provided helpful. Features such as self -racking and inclusion of social and environmental aspects of falls prevention were liked by the participants. Important feedback for successful implementation of the digital intervention was also obtained from the user -testing. CONCLUSIONS To our knowledge, this is the first study to apply the Behaviour Change Wheel to develop a digital intervention for child injury prevention. This work provides a detailed example of evidence-based development of a behaviour theory informed mobile intervention for injury prevention refined using the person-based approach.

Download Full-text

Faculty and Resident Perspectives on Using Entrustment Anchors for Workplace-Based Assessment

Journal of Graduate Medical Education ◽

10.4300/jgme-d-18-01003.1 ◽

2019 ◽

Vol 11 (3) ◽

pp. 287-294 ◽

Cited By ~ 3

Author(s):

Nancy Dudek ◽

Wade Gofton ◽

Janelle Rekman ◽

Allan McDougall

Keyword(s):

Normative Data ◽

Phase 1 ◽

Assessment Tools ◽

Constructivist Grounded Theory ◽

Pragmatic Language ◽

Phase 2 ◽

Training Outcomes ◽

Data Collection And Analysis ◽

Semistructured Interviews ◽

Workplace Based Assessment

ABSTRACT Background Research suggests that workplace-based assessment (WBA) tools using entrustment anchors provide more reliable assessments than those using traditional anchors. There is a lack of evidence describing how and why entrustment anchors work. Objective The purpose of this study is to better understand the experience of residents and faculty with respect to traditional and entrustment anchors. Methods We used constructivist grounded theory to guide data collection and analysis (March–December 2017) and semistructured interviews to gather reflections on anchors. Phase 1 involved residents and faculty (n = 12) who had only used assessment tools with traditional anchors. Phase 2 involved participants who had used tools with entrustment anchors (n = 10). Data were analyzed iteratively. Results Participants expressed that the pragmatic language of entrustment anchors made WBA (1) concrete and justifiable; (2) transparent as they explicitly link clinical assessment and learning progress; and (3) align with training outcomes, enabling better feedback. Participants with no prior experience using entrustment anchors outlined contextual concerns regarding their use. Participants with experience described how they addressed these concerns. Participants expressed that entrustment anchors leave a gap in assessment information because they do not provide normative data. Conclusions Insights from this analysis contribute to a theoretical framework of benefits and challenges related to the adoption of entrustment anchors. This richer understanding of faculty and resident perspectives of entrustment anchors may assist WBA developers in creating more acceptable tools and inform the necessary faculty development initiatives that must accompany the use of these new WBA tools.

Download Full-text

The role of trained champions in sustaining and spreading nutrition care improvements in hospital: qualitative interviews following an implementation study

BMJ Nutrition, Prevention & Health ◽

10.1136/bmjnph-2021-000281 ◽

2021 ◽

pp. e000281

Author(s):

Celia Laur ◽

Jack Bell ◽

Renata Valaitis ◽

Sumantra Ray ◽

Heather Keller

Keyword(s):

Phase 1 ◽

Qualitative Interviews ◽

Audit And Feedback ◽

Routine Practice ◽

Phase 2 ◽

Process Measures ◽

Link Type ◽

Nutrition Care ◽

Registration Number

BackgroundMany patients are already malnourished when admitted to hospital. Barriers and facilitators to nutrition care in hospital have been identified and successful interventions developed; however, few studies have explored how to sustain and spread improvements. The More-2-Eat phase 1 study involved five hospitals across Canada implementing nutrition care improvements, while phase 2 implemented a scalable model using trained champions, audit and feedback, a community of practice with external mentorship and an implementation toolkit in 10 hospitals (four continuing from phase 1). Process measures showed that screening and assessment from phase 1 were sustained for at least 4 years. The objective of this study was to help explain how these nutrition care improvements were sustained and spread by understanding the role of the trained champions, and to confirm and expand on themes identified in phase 1.MethodsSemistructured telephone interviews were conducted with champions from each phase 2 hospital and recordings transcribed verbatim. To explore the champion role, transcripts were deductively coded to the 3C model of Concept, Competence and Capacity. Phase 2 transcripts were also deductively coded to themes identified in phase 1 interviews and focus groups.ResultsTen interviews (n=14 champions) were conducted. To sustain and spread nutrition care improvements, champions needed to understand the Concepts of change management, implementation, adaptation, sustainability and spread in order to embed changes into routine practice. Champions also needed the Competence, including the skills to identify, support and empower new champions, thus sharing the responsibility. Capacity, including time, resources and leadership support, was the most important facilitator for staying engaged, and the most challenging. All themes identified in qualitative interviews in phase 1 were applicable 4 years later and were mentioned by new phase 2 hospitals. There was increased emphasis on audit and feedback, and the need for standardisation to support embedding into current practice.ConclusionTrained local champions were required for implementation. By understanding key concepts, with appropriate and evolving competence and capacity, champions supported sustainability and spread of nutrition care improvements. Understanding the role of champions in supporting implementation, spread and sustainability of nutrition care improvements can help other hospitals when planning for and implementing these improvements.Trial registration numberNCT02800304, NCT03391752.

Download Full-text