Developing mHealth to the Context and Valuation of Injured Patients and Professionals in Hospital Trauma Care: Mixed Methods Study (Preprint)

2021 ◽  
Author(s):  
Thymen Houwen ◽  
Miel A. P. Vugts ◽  
Koen W.W. Lansink ◽  
Hilco P. Theeuwes ◽  
Nicky Neequaye ◽  
...  
Keyword(s):  
Mixed Methods ◽  
Patient Information ◽  
Trauma Care ◽  
Health Care Professionals ◽  
Psychosocial Functioning ◽  
Psychosocial Support ◽  
End Users ◽  
Easy Access ◽  
Trauma Patients ◽  
Value Drivers

BACKGROUND Trauma care faces challenges to innovate their services, such as with mHealth applications, to improve quality of care and patients experience of health. For developing and preparing the future implementation of such innovations, systematic needs inquiries and collaborations with professional and patient end-users are highly recommended. OBJECTIVE To develop a trauma-mHealth application for patient information and support in accordance with the CeHRes roadmap, and describe (1) experiences of (unmet) information and support needs of injured trauma patients; (2) barriers and facilitators for trauma care professionals for the provision of information and support; (3) drivers of value of a mhealth application in trauma patients and trauma care professionals. METHODS Formative evaluations were conducted using mixed methods. Ten semi structured interviews with trauma patients and a focus group with trauma care professionals were conducted for contextual inquiry and value specification. User requirements and value drivers were applied in prototyping. Furthermore, a complementary quantitative discrete-choice experiment (DCE) was conducted with 109 Dutch trauma surgeons to triangulate the results on value specification. In the DCE, preferences were stated over hypothetical mHealth products with various ‘attributes’. The panel data from the DCE were analyzed with conditional and mixed logit models. RESULTS In the interviews patients disclosed a need for more psychosocial support and easy access to more extensive information on their injury, its consequences and future prospects. Health care professionals designated workload as a crucial issue; a digital solution should not cost additional time. The DCE showed that access to patient application data through Electronic Medical Record integration or a web-viewer was considered most important in a mhealth solution by surgeons, followed by the inclusion of periodic self-measurements, local adjustment of patient information, local hospital identification, complication detection, and personalization of rehabilitation through artificial intelligence (all p-values <.05). CONCLUSIONS In the context of trauma care, end-users have a broad range of requirements for a mHealth solution to also address psychosocial functioning, dependable information and possibly a prediction on how a patients ‘recovery trajectory is evolving. A structured development approach provided insights into value drivers, and facilitated mHealth prototype enhancement. Nonetheless, iterative development has to continue to proceed from simple and readily implementable mHealth solutions to ones that end-users appreciate. Hereto, this study can inspire the care community.

scholarly journals A Psychosocial Support Website From the British Association of Dermatologists for People Living With a Skin Condition: Mixed Methods Evaluation

10.2196/17052 ◽  
2020 ◽  
Vol 3 (1) ◽  
pp. e17052 ◽  
Author(s):  
Connor Heapy ◽  
Kerry Montgomery ◽  
Steven Ersser ◽  
Matt Gass ◽  
Nina Goad ◽  
...  
Keyword(s):  
Mixed Methods ◽  
Health Care Professionals ◽  
Psychosocial Support ◽  
Qualitative Content Analysis ◽  
Well Being ◽  
Skin Condition ◽  
British Association ◽  
Self Help ◽  
Skin Conditions ◽  
Qualitative Responses

Background There is a lack of psychological support for individuals with skin conditions, and few low-intensity self-help interventions are available. Objective This study aimed to test the acceptability and usability of a support website and its embedded self-help resources. Methods A mixed methods approach was utilized. A total of 583 participants (426 with a skin condition, 97 relatives and friends, and 60 dermatology professionals) viewed the British Association of Dermatologist’s SkinSupport website and then completed a survey about their well-being and the usability of the website. A comparison group comprising 816 participants also completed the well-being measures. In total, 37 participants (19 living with a skin condition, and the relatives and friends of individuals with a skin condition, and 18 dermatology professionals) viewed the SkinSupport website and then took part in focus groups. Participants were recruited via social media, professional networks, and volunteer lists. Data from the survey were analyzed using descriptive and inferential statistics and qualitative content analysis. Results Both quantitative and qualitative responses suggest that the SkinSupport website was viewed positively by both patients and health professionals. Overall, 79.8% (417/523) of individuals with a skin condition, and the relatives and friends of individuals with a skin condition, said that they would use the website again; and 86.7% (52/60) of dermatology professionals said that they would recommend the site to somebody with a skin condition. Qualitative responses related to the website fell into 4 key themes: (1) appearance, (2) use and navigation, (3) information, and (4) areas for development. Conclusions The SkinSupport website was considered acceptable and usable. A range of areas requiring modification were identified. The website provides a useful resource that patients can access freely. Given the lack of services available to patients with skin conditions, health care professionals could routinely inform patients of this resource at assessment.

scholarly journals Psychosocial support for families of children with neurodisability who have or are considering a gastrostomy: the G-PATH mixed-methods study

2020 ◽  
Vol 8 (38) ◽  
pp. 1-126
Author(s):  
Gillian M Craig ◽  
Eva Brown Hajdukova ◽  
Celia Harding ◽  
Chris Flood ◽  
Christine McCourt ◽  
...  
Keyword(s):  
Mixed Methods ◽  
Health Services ◽  
Willingness To Pay ◽  
Health Care Professionals ◽  
Psychosocial Support ◽  
Clinical Care ◽  
Research Programme ◽  
Mixed Methods Study ◽  
Care Pathways ◽  
The Cost

Background Evidence reviews recommend consistent and structured support for children with neurodisability and their caregivers in care pathways in which professionals recommend a gastrostomy feeding tube. To date, and to our knowledge, no research has shown how these recommendations have been implemented. Objectives The objectives were to describe different exemplar models of psychosocial support and provide an estimate of their resources and costs. Design This was a mixed-methods study involving (1) a web-based survey, (2) a qualitative, collective case study of psychosocial support provision in four services and (3) an estimate of costs and preference through a willingness-to-pay study. Setting Four service configurations in different locations in England and Scotland. Participants Participants were staff who responded to a survey (n = 67) and interviewees (staff, n = 58; parents/children, n = 29). Findings Psychosocial support was rarely formalised or documented; it was delivered by different members of the multidisciplinary team, rather than by designated staff, and it was often integrated into appointments dominated by clinical care. Parents expressed different needs for support but reported little opportunity to discuss emotional aspects. Psychologists were not routinely involved and, in general, families were underserved by psychosocial services. Professionals constructed families’ need for psychosocial support in terms of their own roles and the management of risk. Mechanisms for integrating and delivering support were identified, including models of care that linked community and tertiary health services and integrated health and education through pooled budgets. Although generally valued by both staff and parents, peer-to-peer parent support was not consistently offered. Barriers included concerns about confidentiality and appropriately matching parents. Parents participated as members of a feeding committee at one site. Three analytical constructs described the provision of psychosocial support: ‘hidden work’, expressing emotional vulnerability and negotiations around risks and values. The cost-of-support study found that there was a mean of 2.25 appointments (n = 8 parents or carers) over the previous 12 months. The cost of health-care professionals’ time spent on providing psychosocial support ranged from £0.00 to £317.37 per child per year, with an average cost of £76.42, at 2017 prices. In the willingness-to-pay study the median rank of enhanced support, involving the opportunity to see a psychologist and parental peers, was significantly higher than that of usual care (n = 96 respondents, both carers and professionals, who completed rating of the service; p < 0.001). Limitations It proved difficult to disseminate a national survey, which resulted in a small number of returns, and to cost the provision of psychosocial support, which we designated as ‘hidden work’, owing to the lack of recording in clinical systems. Moreover, estimates were based on small numbers. Conclusions Parent interviews and the willingness-to-pay study demonstrated a preference for enhanced psychosocial support. The study suggests that there is a need for services to formally assess families’ needs for psychosocial support to ensure that provision is planned, costed and made explicit in care pathways. Personalised interventions may assist with the targeting of resources and ensuring that there is an appropriate balance in focus on both clinical care and psychosocial support needs in relation to and following treatment. Future work More work is needed to develop tools to assess families’ needs for psychosocial support and the effectiveness of training packages to strengthen team competency in providing support. Funding This project was funded by the National Institute for Health Research (NIHR) Health Services and Delivery Research programme and will be published in full in Health Services and Delivery Research; Vol. 8, No. 38. See the NIHR Journals Library website for further project information.

scholarly journals A Psychosocial Support Website From the British Association of Dermatologists for People Living With a Skin Condition: Mixed Methods Evaluation (Preprint)

2019 ◽  
Author(s):  
Connor Heapy ◽  
Kerry Montgomery ◽  
Steven Ersser ◽  
Matt Gass ◽  
Nina Goad ◽  
...  
Keyword(s):  
Mixed Methods ◽  
Health Care Professionals ◽  
Psychosocial Support ◽  
Qualitative Content Analysis ◽  
Well Being ◽  
Skin Condition ◽  
British Association ◽  
Self Help ◽  
Skin Conditions ◽  
Qualitative Responses

BACKGROUND There is a lack of psychological support for individuals with skin conditions, and few low-intensity self-help interventions are available. OBJECTIVE This study aimed to test the acceptability and usability of a support website and its embedded self-help resources. METHODS A mixed methods approach was utilized. A total of 583 participants (426 with a skin condition, 97 relatives and friends, and 60 dermatology professionals) viewed the British Association of Dermatologist’s <i>SkinSupport</i> website and then completed a survey about their well-being and the usability of the website. A comparison group comprising 816 participants also completed the well-being measures. In total, 37 participants (19 living with a skin condition, and the relatives and friends of individuals with a skin condition, and 18 dermatology professionals) viewed the <i>SkinSupport</i> website and then took part in focus groups. Participants were recruited via social media, professional networks, and volunteer lists. Data from the survey were analyzed using descriptive and inferential statistics and qualitative content analysis. RESULTS Both quantitative and qualitative responses suggest that the <i>SkinSupport</i> website was viewed positively by both patients and health professionals. Overall, 79.8% (417/523) of individuals with a skin condition, and the relatives and friends of individuals with a skin condition, said that they would use the website again; and 86.7% (52/60) of dermatology professionals said that they would recommend the site to somebody with a skin condition. Qualitative responses related to the website fell into 4 key themes: (1) appearance, (2) use and navigation, (3) information, and (4) areas for development. CONCLUSIONS The <i>SkinSupport</i> website was considered acceptable and usable. A range of areas requiring modification were identified. The website provides a useful resource that patients can access freely. Given the lack of services available to patients with skin conditions, health care professionals could routinely inform patients of this resource at assessment.

scholarly journals 32.K. Skills building seminar: Using participatory health research to optimise psycho-oncological patient information material

2020 ◽  
Vol 30 (Supplement_5) ◽  
Author(s):  
◽  
Keyword(s):  
Patient Information ◽  
Health Research ◽  
Service Providers ◽  
Complex Interventions ◽  
User Participation ◽  
End Users ◽  
Vulnerable Groups ◽  
Participatory Health Research ◽  
Practical Instrument

Abstract Patient information material (PIM) is omnipresent in healthcare. It is used to convey information or to familiarize potential end-users to offers of support. PIM recaps or elaborates on relevant information and offers recommendation for action. However, the quality of available PIM varies. When the formal and content-related quality of PIM is suboptimal, it not only fails to be effective but can also lead to uncertainty, misunderstandings, resistance or ignorance (e.g. of a support offer). Highly complex information requires much attention on the quality of the PIM, especially with respect to end-users (e.g. vulnerable groups). Excellent communication through the use of PIM is thus essential within complex interventions. Checklists, such as 'Discern' or 'PEMAT', as well as criteria catalogues or evidence-based patient information standards, may assist in the development, quality assessment and optimization of PIM. The inclusion of the end-users is recommended but for various reasons does not often take place. The innovative “integrated, cross-sectional Psycho-Oncology” (isPO) programme, offers needs-driven, professional support to all adult, newly diagnosed cancer patients early in their sickness trajectory. IsPO was developed in 2018. It was implemented and a formative evaluated in 2019. When developing this programme, different PIM were created top-down by the programme designers. During implementation, it became evident that these PIM materials required further improvement. A testing and optimization process started using the participatory health research (PHR) approach and was completed in a five-month period. A PIM-optimisation team was founded, which included the project partners involved in the network support, self-help organisations and the external evaluation institute. A practical instrument (PIM-checklist) for optimising the isPO-PIM was designed, piloted and used for testing by end-users, isPO service providers, and experts. Based on the recommendations in the checklist, the material was revised accordingly. Additionally, the PIM was completed with the design of two new components. Four optimisation rounds were conducted. The optimized PIM was tested on its comprehensibility (for end-users) and its usability (for service providers). During the presentations, the audience is invited to comment on critical questions that may appear during optimization (e.g. timing). Afterwards, there will be a skill building part with a focus on collaborative learning (45 minutes). First, we will focus on the requirements for a practical instrument that is handy for end-users, service providers and experts (mind mapping exercise). Finally, participants will be able to explore the following topics “World Café” discussion: (1) how to plan, conduct and communicate the development of optimization of PIM in a CI program, (2) what needs to be considered for the optimization (e.g. team composition, resources), and (3) how to continuously achieve end-userś participation. Key messages Excellent PIM are essential for a complex interventiońs success in practice and must include information and foster actionability. the iterative PIM design processes benefits from high user participation.

scholarly journals Effectiveness of trauma care systems at different stages of development in reducing mortality: a systematic review and meta-analysis protocol

BMJ Open ◽  
2021 ◽  
Vol 11 (6) ◽  
pp. e047439
Author(s):  
Rayan Jafnan Alharbi ◽  
Virginia Lewis ◽  
Sumina Shrestha ◽  
Charne Miller
Keyword(s):  
Systematic Review ◽  
Trauma Care ◽  
Data Extraction ◽  
Meta Analysis ◽  
Trauma System ◽  
Secondary Data ◽  
Trauma Centre ◽  
Trauma Patients ◽  
Trauma Systems ◽  
Stages Of Development

IntroductionThe introduction of trauma systems that began in the 1970s resulted in improved trauma care and a decreased rate of morbidity and mortality of trauma patients. Worldwide, little is known about the effectiveness of trauma care system at different stages of development, from establishing a trauma centre, to implementing a trauma system and as trauma systems mature. The objective of this study is to extract and analyse data from research that evaluates mortality rates according to different stages of trauma system development globally.Methods and analysisThe proposed review will comply with the checklist of the ‘Preferred reporting items for systematic review and meta-analysis’. In this review, only peer-reviewed articles written in English, human-related studies and published between January 2000 and December 2020 will be included. Articles will be retrieved from MEDLINE, EMBASE and CINAHL. Additional articles will be identified from other sources such as references of included articles and author lists. Two independent authors will assess the eligibility of studies as well as critically appraise and assess the methodological quality of all included studies using the Cochrane Risk of Bias for Non-randomised Studies of Interventions tool. Two independent authors will extract the data to minimise errors and bias during the process of data extraction using an extraction tool developed by the authors. For analysis calculation, effect sizes will be expressed as risk ratios or ORs for dichotomous data or weighted (or standardised) mean differences and 95% CIs for continuous data in this systematic review.Ethics and disseminationThis systematic review will use secondary data only, therefore, research ethics approval is not required. The results from this study will be submitted to a peer-review journal for publication and we will present our findings at national and international conferences.PROSPERO registration numberCRD42019142842.

scholarly journals Bringing Psychosocial Support to Headache Sufferers Using Information and Communication Technology: Lessons Learned from Asking Potential Users What they Want

2014 ◽  
Vol 19 (1) ◽  
pp. e1-e8 ◽  
Author(s):  
Anna Huguet ◽  
Jennifer Stinson ◽  
Bonnie MacKay ◽  
Carolyn Watters ◽  
Michelle Tougas ◽  
...  
Keyword(s):  
Participatory Design ◽  
Psychosocial Support ◽  
Management Strategies ◽  
Psychosocial Interventions ◽  
Daily Basis ◽  
User Preferences ◽  
Lessons Learned ◽  
Easy Access ◽  
Theoretical Frameworks ◽  
Pain Diary

BACKGROUND: Headaches are a major concern for which psychosocial interventions are recommended. However, headache sufferers do not always have ready access to these interventions. Technology has been used to improve access, especially in young people.OBJECTIVES: To examine user preferences to inform the development of an Internet-based psychosocial intervention including smartphone technology, referred to as the Wireless Headache Intervention.METHODS: The methodology followed a participatory design cycle, including 25 headache sufferers (14 to 28 years of age) who informed the prototype design. All participants were familiar with smartphones and the Internet. Through two iterative cycles of focus groups stratified according to age, qualitative data were collected by asking user preferences for the different planned components of the intervention (ie, smartphone pain diary, Internet-based self-management treatment, social support) and other relevant aspects (ie, smartphone versus computer delivery, and ways of reaching target audience). NVivo 8 with content analysis was used to analyze data and reflect themes as guided by the thematic survey.RESULTS: Participants reported a preference for completing the smart-phone pain diary on a daily basis. Participants believed that the program should facilitate easy access to information regarding headaches and management strategies. They also wanted access to other headache sufferers and experts. Participants believed that the program should be customizable and interactive. They reinforced the need and value of an integrated smartphone and Internet-based application.CONCLUSIONS: The results provide insight into a participatory design to guide design decisions for the type of intervention for which success relies largely on self-motivation. The results also provide recommendations for design of similar interventions that may benefit from the integration of mobile applications to Internet-based interventions. The present research contributes to the theoretical frameworks that have been formulated for the development of Internet-based applications.

scholarly journals A mixed methods evaluation of the Paediatric Musculoskeletal Matters (PMM) online portfolio

2021 ◽  
Vol 19 (1) ◽  
Author(s):  
Nicola Smith ◽  
Helen E. Foster ◽  
Sharmila Jandial
Keyword(s):  
Mixed Methods ◽  
Health Care Professionals ◽  
Online Survey ◽  
User Feedback ◽  
User Engagement ◽  
Allied Health Professionals ◽  
Clinical Images ◽  
Survey Interviews ◽  
Training Programmes ◽  
Method Of Evaluation

Abstract Background The PMM Portfolio is comprised of the Paediatric Musculoskeletal Matters (PMM) website, the paediatric Gait, Arms, Legs and Spine (pGALS) app and e-learning modules (ELM). The target audiences are non-specialists in paediatric musculoskeletal medicine. Our study aimed to evaluate impact on learning and clinical practice. Methods Mixed methods (analytics, online survey, interviews) were used with PMM and ELM registered users and purposive sampling of users using international contacts within paediatrics and paediatric rheumatology. Data was analysed using descriptive statistics and qualitative techniques. A Paired T-Test compared self-rated confidence before and after use of the PMM Portfolio. Results There has been wide reach for all the e-resources; PMM website (662,827 hits, 262,476 users, 214 countries, data 31st July 2020); pGALS app (12,670 downloads, 70 countries, data 31st July 2020); ELM (150 users, 30 countries, data 30th May 2019). There were 164 responses (students, trainees and health care professionals) to the survey from 25 countries. Most responders deemed the PMM Portfolio useful / very useful for their learning with significantly increased self-rated confidence in their clinical examination and reasoning skills following access to the PMM website, p = < 0.01, pGALS app, p = < 0.01 and ELM, p = < 0.01. The most popular PMM website pages related to clinical assessment techniques (especially pGALS). There was high uptake of the pGALS app and pGALS ELM especially from trainees and allied health professionals. Many clinicians reported the PMM Portfolio to be useful when used to teach others. User feedback reported that easy navigation, open access, clinical images and cases were the most valued features. User feedback highlighted need to increase awareness of the e-resources through training programmes. Conclusions The PMM Portfolio was developed to aid learning for clinicians who are not specialists in paediatric MSK medicine. Our evaluation demonstrates wide international reach and positive feedback on learning. The PMM Portfolio is a highly useful e-resource for paediatric rheumatologists in their teaching of others to raise awareness, facilitate early diagnosis and referral of children with suspected disease. The wide user engagement informed future PMM Portfolio development and the mixed method of evaluation is transferable to other e-resources.

scholarly journals Technology Acceptance of a Machine Learning Algorithm Predicting Delirium in a Clinical Setting: a Mixed-Methods Study

2021 ◽  
Vol 45 (4) ◽  
Author(s):  
Stefanie Jauk ◽  
Diether Kramer ◽  
Alexander Avian ◽  
Andrea Berghold ◽  
Werner Leodolter ◽  
...  
Keyword(s):  
Machine Learning ◽  
Mixed Methods ◽  
Technology Acceptance ◽  
Health Care Professionals ◽  
User Acceptance ◽  
Ease Of Use ◽  
Perceived Usefulness ◽  
Actual System ◽  
System Use ◽  
Delirium Management

AbstractEarly identification of patients with life-threatening risks such as delirium is crucial in order to initiate preventive actions as quickly as possible. Despite intense research on machine learning for the prediction of clinical outcomes, the acceptance of the integration of such complex models in clinical routine remains unclear. The aim of this study was to evaluate user acceptance of an already implemented machine learning-based application predicting the risk of delirium for in-patients. We applied a mixed methods design to collect opinions and concerns from health care professionals including physicians and nurses who regularly used the application. The evaluation was framed by the Technology Acceptance Model assessing perceived ease of use, perceived usefulness, actual system use and output quality of the application. Questionnaire results from 47 nurses and physicians as well as qualitative results of four expert group meetings rated the overall usefulness of the delirium prediction positively. For healthcare professionals, the visualization and presented information was understandable, the application was easy to use and the additional information for delirium management was appreciated. The application did not increase their workload, but the actual system use was still low during the pilot study. Our study provides insights into the user acceptance of a machine learning-based application supporting delirium management in hospitals. In order to improve quality and safety in healthcare, computerized decision support should predict actionable events and be highly accepted by users.

scholarly journals Effect of Under Triage on Early Mortality After Major Pediatric Trauma: A Registry-based Propensity Score Matching Analysis

2020 ◽  
Author(s):  
François-Xavier Ageron ◽  
Jordan Porteaud ◽  
Jean-Noël Evain ◽  
Anne Millet ◽  
Jules Greze ◽  
...  
Keyword(s):  
Propensity Score ◽  
Trauma Care ◽  
Pediatric Population ◽  
Pediatric Trauma ◽  
Trauma System ◽  
Early Death ◽  
Risk Difference ◽  
Early Mortality ◽  
Trauma Patients ◽  
Risk Of Death

Abstract Backgroundlittle is known about the effect of under triage on early mortality in trauma in a pediatric population. Our objective is to describe the effect of under triage on 24 hour-mortality after major pediatric trauma in a regional trauma systemMethodsThis cohort study was conducted from January 2009 to December 2017. Data were obtained from the registry of the Northern French Alps Trauma System. The network guidelines triage pediatric trauma patients according to an algorithm shared with adult patients. Under triage was defined by the number of pediatric trauma patients that required specialized trauma care transported to a non-level I pediatric trauma center on the total number of injured patients with critical resource use. The effect of under triage on 24 hour-mortality was assessed with inverse probability treatment weighting (IPTW) and a propensity score (Ps) matching analysis. ResultsA total of 1 143 pediatric patients were included (mean [SD], age 10 [5] years), mainly after a blunt trauma (1130 [99%]). Of the children, 402 (35%) had an ISS higher than 15 and 547 (48%) required specialized trauma care. Nineteen (1.7%) patients died within 24 hours. Under triage rate was 33% based on the need of specialized trauma care. Under triage of children requiring specialized trauma care increased the risk of death in IPTW (risk difference: 6.0 [95% CI 1.3-10.7]) and Ps matching analyses (risk difference: 3.1 [95% CI 0.8-5.4]).ConclusionsIn a regional inclusive trauma system, under triage increased the risk of early death after pediatric major trauma.

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