User-centred design of a novel risk prediction behaviour change tool augmented with an Artificial Intelligence engine (MyDiabetesIQ): A sociotechnical systems approach (Preprint)

2021 ◽  
Author(s):  
Cathy Shields ◽  
Scott G Cunningham ◽  
Deborah J Wake ◽  
Evridiki Fioratou ◽  
Doogie Brodie ◽  
...  

BACKGROUND Diabetes and its complications account for 10% of annual UK healthcare spending. Digital healthcare interventions (DHIs) can provide scalable care, fostering diabetes self-management and reducing the risk of complications. Tailorability and usability are key to DHI engagement/effectiveness. User-centred design of DHIs, aligning features to end users’ needs, can generate more usable interventions, avoiding unintended consequences and improving user engagement. OBJECTIVE MyDiabetesIQ is an Artificial Intelligence engine, intended to provide users with tailored forecasts of their diabetes complications risk. It will underpin a user interface in which users will alter lifestyle parameters to see the impact this has on future risks,. MyDiabetesIQ will link to an existing DHI, My Diabetes My Way (MDMW). We describe user-centred design, informed by human factors engineering, of the user interface of MyDiabetesIQ. METHODS Current users of MDMW were invited to take part in focus groups to gather their insights about users being shown their complications risks, and any risks they perceived from using MyDiabetesIQ. Findings from focus groups informed the development of a prototype MyDiabetesIQ interface. The prototype was user tested through the ‘think aloud’ method, in which users speak aloud about their thoughts/impressions while performing prescribed tasks. Focus group and think aloud transcripts were analysed thematically (a combination of inductive and deductive analysis). For think aloud data, a sociotechnical model was used as a framework for thematic analysis. RESULTS Focus group participants (n=8) felt that some users could become anxious when shown their future complications risks. They highlighted the importance of easy navigation, avoidance of jargon, and use of positive/encouraging language. User testing of the prototype site through think aloud sessions (n=7) highlighted several usability issues. Issues included confusing visual cues and confusion over whether user-updated information fed back to healthcare teams. Some issues could be compounded for users with limited digital skills. Results of focus groups and think aloud workshops are being used in the development of a live MyDiabetesIQ platform. CONCLUSIONS Acting on the input of end users at each iterative stage of development can help to prioritise users throughout the design process, ensuring alignment of DHI features with their needs. Use of the sociotechnical framework encouraged consideration of interactions between different sociotechnical dimensions in finding solutions to issues, for example avoiding the exclusion of users with limited digital skills. Based on user feedback, the tool could scaffold good goal setting, allowing users to balance their palatable future complications risk against acceptable lifestyle changes. Good control of diabetes relies heavily on self-management. Tools such as MDMW/MyDiabetesIQ can offer personalised support for self-management alongside access to users’ electronic health records, potentially helping to delay or reduce long-term complications, thereby providing significant reductions in healthcare costs.

2021 ◽  
Author(s):  
Gayl Humphrey ◽  
Joanna Chu ◽  
Rebecca Ruwhui-Collins ◽  
Stephanie Erick ◽  
Nicki Dowling ◽  
...  

BACKGROUND Many people experiencing harms and problems from gambling do not seek treatment from gambling treatment services due to numerous personal and resource barriers. Mobile health (mHealth) interventions are widely used across a diverse range of health care areas and by various population groups, but there are few in the gambling harm field, despite their potential as an additional modality for the delivery of treatment. OBJECTIVE This study aims to understand the needs, preferences and priorities of people experiencing gambling harms or problems who are potential end-users of a cognitive behavioural therapy (CBT) mHealth intervention (based on the GAMBLINGLESS web-based intervention) to inform design features and functions. METHODS Drawing on a mixed-methods approach, we used the creators and domain experts to review the GAMBLINGLESS web-based online program and convert it into a prototype for a mobile phone-based intervention. Each module was reviewed against the original evidence-base to ensure that the changes maintained the fidelity and conceptual integrity intended and to ensure that there were no gaps. Early wireframes, design ideas (look, feel and function) and content examples were to be developed using multi-modalities, to help initiate discussions and ideas with end-users. Using an iterative co-creation process with a Young Adult, a Māori and a Pasifika Peoples group, all with experiences of problem or harmful gambling, we undertook six focus groups; two cycles per group. During each focus group, participants identified preferences, features, and functions for inclusion in a final design of the mHealth intervention and its content. RESULTS Over three months, the GAMBLINGLESS web-based intervention was reviewed and remapped from four modules to six. This revised program is based on the principles underpinning the Transtheoretical Model, in which it is recognised that some end-users will be more ready to change than others, change is a process than unfolds over time, a non-linear progression is common, and that different intervention options may be required by end-users across the stages of change. Two cycles of focus groups were then conducted, with a total of 30 unique participants (13 Māori, 9 Pasifika and 8 Young Adults) at the first sessions and 18 participants (7 Māori, 6 Pasifika and 5 Young Adults) at the second sessions. Using prototype examples that demonstrably reflected the focus group discussions and ideas, the features, functions and designs for the Manaaki app were finalised. Aspects such as personalisation, cultural relevance, and being positively framed were key attributes identified. Congruence of the final app attributes with the conceptual frameworks of the original program was also confirmed. CONCLUSIONS Those who experience gambling harms may not seek help from current treatment providers and as such, finding new modalities to provided treatment and support are needed. mHealth has the potential to deliver interventions direct to the end-user. Weaving underpinning theory and existing evidence of effective treatment with end-user input into the design and development of the mHealth intervention does not guarantee success. However, it does provide a foundation for framing the mechanism, context and content of the intervention and arguably provides a greater chance of demonstrating effectiveness.


10.2196/19519 ◽  
2021 ◽  
Vol 8 (1) ◽  
pp. e19519
Author(s):  
Julie Richardson ◽  
Lori Letts ◽  
Susanne Sinclair ◽  
David Chan ◽  
Jordan Miller ◽  
...  

Background The global rise in the incidence of chronic conditions and aging is associated with increased disability. Physiotherapists and occupational therapists can mitigate the resulting burden on the health care system with their expertise in optimizing function. Rehabilitation self-management strategies can assist people with chronic conditions to accept, adjust, and manage different aspects of their daily functioning. Interventions delivered using technology have the potential to increase the accessibility, availability, and affordability of rehabilitation self-management support and services. Objective This study aims to describe the development and usability evaluation of iamable, a web-based app created to provide rehabilitation self-management support for people with chronic conditions. Methods The development and evaluation of iamable were undertaken in several phases. We used user-centered design principles and an iterative process that included consultations with rehabilitation experts; developed a prototype; and conducted usability tests, heuristic evaluations, and a focus group analysis. Results The iamable app was developed to provide rehabilitation self-management strategies in the areas of exercise, fall prevention, fatigue management, pain management, physical activity, and stress management. We engaged adults aged ≥45 years with at least one chronic condition (N=11) in usability testing. They identified navigation and the understanding of instructions as the primary issues for end users. During the heuristic evaluation, clinicians (N=6) recommended that some areas of app content should be more succinct and that help should be more readily available. The focus group provided input to help guide clinical simulation testing, including strategies for selecting patients and overcoming barriers to implementation. Conclusions We engaged end users and clinicians in the development and evaluation of the iamable app in an effort to create a web-based tool that was useful to therapists and their patients. By addressing usability issues, we were able to ensure that patients had access to rehabilitation strategies that could be used to help them better manage their health. Our app also provides therapists with a platform that they can trust to empower their patients to be more active in the management of chronic conditions. This paper provides a resource that can be used by others to develop and evaluate web-based health apps.


Pain Medicine ◽  
2018 ◽  
Vol 21 (2) ◽  
pp. e1-e8 ◽  
Author(s):  
Barbara J Turner ◽  
Natalia Rodriguez ◽  
Raudel Bobadilla ◽  
Arthur E Hernandez ◽  
Zenong Yin

Abstract Objective To examine factors influencing initial engagement, ongoing participation, learned behaviors, and subjective functional outcomes after a trial of the Living Better Beyond Pain (LBBP) chronic pain self-management program. Design Qualitative study using the Grounded Theory approach. Setting Two 60-minute focus groups and phone interviews in May 2017. Subjects Focus groups with 18 participants who completed LBBP and six-month measures; telephone interviews with 17 participants who stopped attending. Methods Study coordinators randomly selected program completers for focus groups and conducted phone interviews with noncompleters. Inductive thematic analysis was used to identify patterns in semantic content with a recursive process applied to focus group transcripts and interview transcriptions to codify into themes. Themes were categorized according to the Theory of Planned Behavior. Results Focus group and telephone interview participants were primarily Hispanic and unemployed. Attitudes fostering participation in LBBP included dissatisfaction with the status quo, need to reduce pain medication, and lack of training and knowledge about chronic pain. Positive social norms from meeting others with chronic pain and support from the LBBP team encouraged attendance and adoption of behaviors. Transportation, pain, and competing activities were barriers, whereas adapting activities for the disabled was a facilitator. Maintaining behaviors and activities at home was challenging but ultimately rewarding due to improvement in daily function with less pain medication. Conclusions This qualitative study complements quantitative results showing clinically significant improvements in function after the LBBP program by adding practical insights into ways to increase participation and outcomes. Participants strongly endorsed the need for chronic pain self-management training.


2020 ◽  
Vol 30 (Supplement_5) ◽  
Author(s):  
S Manship ◽  
E Hatzidimitriadou ◽  
R Morris ◽  
S Hulbert ◽  
J Webster ◽  
...  

Abstract Initiatives to increase effective, low-cost self-management are essential to the sustainability of care for type 2 diabetes (T2D), however research shows that there is currently no standard approach. The DWELL programme seeks to motivate and empower people with T2D to better self-manage their condition through focussed content underpinned by motivational interviewing. As part of the DWELL evaluation study, end-of-programme focus groups were conducted to elicit participant experiences. 33 focus groups with 153 participants (including a small number of partners) took place in the two UK DWELL delivery sites. The focus group data was subjected to thematic content analysis to elicit key themes. Findings indicate that DWELL participants are motivated through a desire for better knowledge and management of their diabetes. Facilitating factors of the programme include: facilitator and peer support; the holistic and autonomous approach which provides participants with the opportunity to better understand the condition and its impact on their whole lives; and a tailored individual approach. Barriers and suggested improvements include content and operational changes, which are fed back to DWELL facilitators as part of the process evaluation in order that they can continually update the programme. Participants report positive outcomes in terms of wellbeing, social and mental health, enhanced knowledge and positive lifestyle changes. These themes align with quantitative outcome measures for participants, including weight loss, reduced BMI and glycated haemoglobin (HbA1c), enhanced empowerment and improved eating behaviours and illness perceptions and control. Interim findings suggest that DWELL outcomes include improved health literacy, participant empowerment and self-management. These findings underscore the need to incorporate a holistic, tailored approach to structured patient education for T2D.


2020 ◽  
Author(s):  
Julie Richardson ◽  
Lori Letts ◽  
Susanne Sinclair ◽  
David Chan ◽  
Jordan Miller ◽  
...  

BACKGROUND The global rise in the incidence of chronic conditions and aging is associated with increased disability. Physiotherapists and occupational therapists can mitigate the resulting burden on the health care system with their expertise in optimizing function. Rehabilitation self-management strategies can assist people with chronic conditions to accept, adjust, and manage different aspects of their daily functioning. Interventions delivered using technology have the potential to increase the accessibility, availability, and affordability of rehabilitation self-management support and services. OBJECTIVE This study aims to describe the development and usability evaluation of iamable, a web-based app created to provide rehabilitation self-management support for people with chronic conditions. METHODS The development and evaluation of iamable were undertaken in several phases. We used user-centered design principles and an iterative process that included consultations with rehabilitation experts; developed a prototype; and conducted usability tests, heuristic evaluations, and a focus group analysis. RESULTS The iamable app was developed to provide rehabilitation self-management strategies in the areas of exercise, fall prevention, fatigue management, pain management, physical activity, and stress management. We engaged adults aged ≥45 years with at least one chronic condition (N=11) in usability testing. They identified navigation and the understanding of instructions as the primary issues for end users. During the heuristic evaluation, clinicians (N=6) recommended that some areas of app content should be more succinct and that help should be more readily available. The focus group provided input to help guide clinical simulation testing, including strategies for selecting patients and overcoming barriers to implementation. CONCLUSIONS We engaged end users and clinicians in the development and evaluation of the iamable app in an effort to create a web-based tool that was useful to therapists and their patients. By addressing usability issues, we were able to ensure that patients had access to rehabilitation strategies that could be used to help them better manage their health. Our app also provides therapists with a platform that they can trust to empower their patients to be more active in the management of chronic conditions. This paper provides a resource that can be used by others to develop and evaluate web-based health apps.


BMJ Open ◽  
2019 ◽  
Vol 9 (9) ◽  
pp. e032468 ◽  
Author(s):  
Hannah Louise Bradwell ◽  
Katie Jane Edwards ◽  
Rhona Winnington ◽  
Serge Thill ◽  
Ray B Jones

ObjectiveCompanion robots, such as Paro, may reduce agitation and depression for older people with dementia. However, contradictory research outcomes suggest robot design is not always optimal. While many researchers suggest user-centred design is important, there is little evidence on the difference this might make. Here, we aimed to assess its importance by comparing companion robot design perceptions between older people (end users) and roboticists (developers).DesignOlder people and roboticists interacted with eight companion robots or alternatives at two separate events in groups of two to four people. Interactions were recorded, participants’ comments and observations were transcribed, and content was analysed. Subsequently, each group participated in focus groups on perceptions of companion robot design. Discussions were recorded and transcribed, and content was analysed.Participants and settingsSeventeen older people (5 male, 12 female, ages 60–99) at a supported living retirement complex, and 18 roboticists (10 male, 8 female, ages 24–37) at a research centre away-day.ResultsWe found significant differences in design preferences between older people and roboticists. Older people desired soft, furry, interactive animals that were familiar and realistic, while unfamiliar forms were perceived as infantilising. By contrast, most roboticists eschewed familiar and realistic designs, thinking unfamiliar forms better suited older people. Older people also expressed desire for features not seen as important by developers. A large difference was seen in attitude towards ability to talk: 12/17 (71%) older people but only 2/18 (11%) roboticists requested speech. Older people responded positively towards life-simulation features, eye contact, robot personalisation and obeying commands, features undervalued by roboticists. These differences were reflected in preferred device, with ‘Joy for All’ cat chosen most often by older people, while roboticists most often chose Paro.ConclusionThe observed misalignment of opinion between end users and developers on desirable design features of companion robots demonstrates the need for user-centred design during development.


2020 ◽  
Vol 14 (Supplement_1) ◽  
pp. S663-S664
Author(s):  
S Fawson ◽  
L Dibley ◽  
K Smith ◽  
J Batista ◽  
M Artom ◽  
...  

Abstract Background As part of the IBD-BOOST programme of research (www.ibd-boost.org), we aimed to understand how people manage fatigue, pain and urgency in inflammatory bowel disease (IBD), and their preferences for an online self-management intervention for this triad of symptoms. Methods Using exploratory qualitative methods we recruited people with IBD from clinic and community sources and conducted focus groups and interviews in different UK locations. Focus groups and interviews were facilitated by experienced qualitative researchers, recorded on a digital audio device and professionally transcribed. Participants were asked to talk about the techniques they have found helpful for managing fatigue, pain, and/or urgency, and their preferred design and functionality of an on-line intervention to support self-management. Individual interviews were used to explore and elaborate on issues raised in focus groups in greater depth. We conducted framework analysis of focus group data and applied it over three rounds of analysis. Interview data were analysed thematically and then integrated with the focus group data. Results Thirty-nine participants (16 females; ages 23–60 years) each attended one of five focus groups (N = 3, 7, 6, 6 and 3), or an individual interview (n = 14). Twenty-four had CD, 13 had UC and three had IBD-U. Duration of disease was three–49 years. Three core themes emerged: Participants discussed the importance of learning to manage all three symptoms simultaneously, and of using techniques to track the link between factors such as food, fluids, stress and exercise, and symptoms. They wanted an accessible online intervention which would work across several platforms (mobile phone, tablet, laptop or desktop computer), to include symptom, medication and activity-tracking features, with options for support from IBD clinicians. Conclusion Fatigue, pain, and urgency commonly occur together, and patients want these managed simultaneously, rather than separate interventions for each symptom. Findings are informing the development of online intervention self-management programme, reflecting patient requests regarding content, access, functionality, and usability.


Author(s):  
Lise Switsers ◽  
Arthur Dauwe ◽  
Anneleen Vanhoudt ◽  
Hilde Van Dyck ◽  
Koen Lombaerts ◽  
...  

BACKGROUND Recent research indicates that current mHealth apps for bipolar disorders (BDs) show crucial shortcomings. They lack important functionality, are of inconsistent quality, and are insufficiently evidence-based. mHealth apps need to be better adapted to the needs of users. The perspectives of adult service users with BD regarding mHealth apps have not been well investigated. OBJECTIVE The objective of this study was to examine the needs and expectations of adults with BD regarding mHealth apps. METHODS Two focus group sessions were organized in which patients’ views on self-management and design and functionality of an mHealth app for BD were assessed. During session 1, four focus groups were organized to identify users’ needs regarding support for self-management. Session 2 contained three cocreation focus groups. Through this method, the desired functionality and design were explored. RESULTS Participants indicated that they were in need of support in various ways. Not only support in psychoeducation, including daily routine, sleep pattern, maintaining social contacts, maintaining a healthy lifestyle, and avoidance of stimuli, was considered important for them but also gaining insight into their illness was found to be crucial. CONCLUSIONS According to the participants, their illness-related information is a key factor in gaining insight into their mood pattern. Participants wanted a functional design that would increase daily use and prevent overstimulation. The results of this study should be taken into account when developing new mHealth apps.


2007 ◽  
Vol 30 (4) ◽  
pp. 61
Author(s):  
S. Malhotra ◽  
R. Hatala ◽  
C.-A. Courneya

The mini-CEX is a 30 minute observed clinical encounter. It can be done in the outpatient, inpatient or emergency room setting. It strives to look at several parameters including a clinical history, physical, professionalism and overall clinical competence. Trainees are rated using a 9-point scoring system: 1-3 unsatisfactory, 4-6 satisfactory and 7-9 superior. Eight months after the introduction of the mini-CEX to the core University of British Columbia Internal Medicine Residents, a one hour semi-structured focus group for residents in each of the three years took place. The focus groups were conducted by an independent moderator, audio-recorded and transcribed. Using a phenomenological approach the comments made by the focus groups participants were read independently by three authors, organized into major themes. In doing so, several intriguing common patterns were revealed on how General Medicine Residents perceive their experience in completing a mini-CEX. The themes include Education, Assessment and Preparation for the Royal College of Physicians and Surgeons Internal Medicine exam. Resident learners perceived that the mini-CEX process provided insight into their clinical strengths and weaknesses. Focus group participants favored that the mini-CEX experience will benefit them in preparation, and successful completion of their licensing exam. Daelmans HE, Overmeer RM, van der Hem-Stockroos HH, Scherpbier AJ, Stehouwer CD, van der Vleuten CP. In-training assessment: qualitative study of effects on supervision and feedback in an undergraduate clinical rotation. Medical Education 2006; 40(1):51-8. De Lima AA, Henquin R, Thierer J, Paulin J, Lamari S, Belcastro F, Van der Vleuten CPM. A qualitative study of the impact on learning of the mini clinical evaluation exercise in postgraduate training. Medical Teacher January 2005; 27(1):46-52. DiCicco-Bloom B, Crabtree BF. The Qualitative Research Interview. Medical Education 2006; 40:314-32.


2020 ◽  
Author(s):  
Kuntal Chowdhary ◽  
Daihua Xie Yu ◽  
Gede Pramana ◽  
Andrea Fairman ◽  
Brad Edward Dicianno ◽  
...  

BACKGROUND Mobile health (mHealth) systems have been shown to be useful in supporting self-management by promoting adherence to schedules and longitudinal health interventions, especially in people with disabilities (PwD). The Interactive Mobile Health and Rehabilitation (iMHere) System was developed to empower PwD and those with chronic conditions with supports needed for self-management and independent living. Since the first iteration of the iMHere 1.0 app, several studies have evaluated accessibility and usability of the system. Potential opportunities to improve and simplify the user interface (UI) were identified, and the iMHere modules were redesigned accordingly. OBJECTIVE The aim of this study was to evaluate the usability of the redesigned modules within iMHere 1.0. METHODS This study evaluated the original and redesigned MyMeds and SkinCare modules. To assess the participants’ dexterity levels, the Purdue Pegboard Test (PPBT) was administered. Participants were then asked to perform a set of tasks using both the original and redesigned MyMeds and SkinCare modules to assess efficiency and effectiveness. Usability was measured using the Telehealth Usability Questionnaire (TUQ) to evaluate 10 new accessibility features that were added to the redesigned app. Participants were also asked which version they preferred. RESULTS Twenty-four participants with disabilities and varied degrees of dexterity impairments completed the entire study protocol. Participants displayed improved efficiency and effectiveness of use when using the redesigned modules, as compared to the original modules. Participants also reported improved usability and preferred the redesigned modules. CONCLUSIONS This study demonstrated that the iMHere System became more efficient, effective, and usable for individuals with dexterity impairments after redesigning it according to user-centered principles.


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