Initial User Testing Research Articles

A virtual 3D Chemistry Escape Room for Exam Preparations

Chemistry can be incredibly captivating. However, learning the theory can often be challenging and less appealing for students. Providing them with hands-on methods in their learning process is beneficial and also helps to lower the barrier for understanding theory. In a gamified approach, the "ChemScape" virtual 3D chemistry escape room, designed as a realistic laboratory with various equipment and hidden chemical tasks, can help solidify chemical knowledge and prepare students for chemistry exams. In 2023, as part of an e-learning project, the foundation of such a chemistry escape room was established, and several chemical questions were incorporated as escape room tasks. The objective is to discover hidden questions within the laboratory, utilize different instruments (such as scales), conduct virtual chemistry experiments, and solve various chemistry questions using theoretical knowledge (such as nomenclature and understanding of pH) in a game-based setting (utilizing multiple-choice, drag and drop, connecting cables, solving color codes, etc.). Typically, a code (comprising numbers, letters, signs, etc.) needs to be obtained for progression. To solve the chemistry tasks, approximately 10 different door-openers have been developed. Initial user tests have been conducted, and adjustments were made based on the feedback received, which was satisfactory and positive. In 2024, the "ChemScape" escape room will evolve from a game with a fixed set of tasks to a dynamic escape room game with a dynamic database that allows for the creation of new questions at the same stations, significantly expanding learning opportunities. A virtual chemistry laboratory rat provides hints if a participant gets stuck and requires assistance. Furthermore, "ChemScape" will be trialed in chemistry lectures and potentially utilized as an additional attraction at events held at the University of Applied Sciences.

Building on Strong Foundations: Deploying Enhanced Replicating Effective Programs for evidence-based prevention curriculum adaptation.

Schools frequently adopt new interventions for each new public health issue, but this is both time- and resource-intensive. Adversity exposure is an example of a pervasive public health issue that emerged during Coronavirus Disease 2019 (COVID-19) with notable consequences, including an elevated risk of developing substance use disorders and mental illnesses. Adapting existing, universal, evidence-based interventions, such as the Michigan Model for HealthTM (MMH), by incorporating trauma-sensitive content is a promising approach to meet this need. We examined critical steps in promoting MMH adaptability as part of the Enhanced REP (Replicating Effective Programs) implementation strategy during the COVID-19 pandemic. We share usability testing from the 2020 to 2021 school year and describe how we apply the results to inform the group randomized trial pilot study. We applied key steps from implementation adaptation frameworks to integrate trauma-sensitive content as COVID-19 unfolded, documenting the process through field notes. We conducted initial usability testing with two teachers via interviews and used a rapid qualitative analysis approach. We conducted member checking by sharing the information with two health coordinators to validate results and inform additional curriculum refinement. We developed an adapted MMH curriculum to include trauma-sensitive content, with adaptations primarily centered on adding content, tailoring content, substituting content, and repeating/reinforcing elements across units. We designed adaptations to retain the core functional elements of MMH. Building foundational relationships and infrastructure supports opportunities to user-test intervention materials for Enhanced REP that enhance utility and relevance for populations that would most benefit. Enhanced REP is a promising strategy to use an existing evidence-based intervention to meet better the needs of youth exposed to adversity. Building on the foundations of existing evidence-based interventions, is vital to implementation success and achieving desired public health outcomes.

Assessing qualitative data richness and thickness: Development of an evidence‐based tool for use in qualitative evidence synthesis

AbstractBackgroundWell‐conducted qualitative evidence syntheses (QESs) can provide invaluable insights into complex phenomena. However, the development of an in‐depth understanding depends on the analysis of rich, thick data from the included primary qualitative studies. Sampling may be needed if there are too many eligible studies. Data richness and thickness are among several criteria that can be taken into consideration when sampling studies for inclusion. However, existing tools do not address explicitly the assessment of both data richness and thickness in the context of QES.MethodsTo address this gap, we have developed, piloted, and conducted initial user testing of a richness and thickness assessment tool. The tool has been in development since 2014. Three pilot versions from three review teams have been used in six Cochrane reviews. Key members from the original three review teams subsequently came together to create a consensus‐based definitive version 1 of the tool. Four review authors piloted the version 1 tool, which has been subject to initial user testing. The version 1 assessment tool consists of two components: assessing the thickness of contextual data and assessing the richness of conceptual data. The accompanying guidance emphasizes the importance of assessing data that addresses the review question.ResultsThe paper provides guidance on how to apply the tool, emphasizing the importance of reaching a consensus among review authors and fostering a shared understanding of what constitutes rich and thick data in the context of the review. The potential challenges related to the time and resource constraints of this additional review process are acknowledged.ConclusionVersion 1 of the tool represents a significant development in QES methodology, filling a critical gap and enhancing the transparency and rigor of the sampling process. The authors invite feedback from the research community to further test, refine and improve this tool based on wider user experiences.

Using virtual and augmented reality to study architectural lighting

This paper presents industry stakeholder insights from the implementation of a dual modality intervention using virtual and augmented reality simulation to study complex lighting theory in architecture design. Using a design based research method the aim is to evaluate these insights and inform a pilot study to educate first year architectural design students on the complexities of lighting the built environment and methods to improve architectural workflow. The aim is to enable learners to experience natural and artificial lighting methods comparatively in real-time through multiple comparative visualisation methods. This is important to make informed evaluations regarding architectural designs in terms of spatial quality, character, performance, and user-comfort levels. This in turn allows architects to rapidly modify their designs to accommodate or mitigate the environmental effects. Outcomes from the initial usability test highlight the ability to switch back and forth between the virtual and augmented reality simulation technology, and between lighting visualisation modes as a huge step forward by the industry stakeholders. Additionally, the idea of representing the physical building where the simulation took place virtually using a detailed mapping gave a real-world anchor that made the simulations easy to navigate, leading to improved satisfaction and engagement. However, the study also highlighted improvements in the delivery of the simulation is required to improve simulation learnability and efficiency.

Fostering Patient-Clinician Communication to Promote Rapid HIV, Hepatitis B Virus, and Hepatitis C Virus Diagnostic Testing: Conceptual Development of a Multilingual App.

Migrants are disproportionately affected by HIV, hepatitis B virus (HBV), and hepatitis C virus (HCV). Clinicians, at times, fail to offer rapid diagnostic testing (RDT) for these viruses when a language barrier exists in the patient-clinician relationship, therefore creating missed testing opportunities. Although their effectiveness has been demonstrated elsewhere, conventional, in-person interpreters are costly and underused in practice. Furthermore, clinicians often call upon ad hoc interpreters, which introduces complexities in the clinical relationship. Digital solutions exist to diminish the burden of language barriers; however, the challenges of developing a multilingual and multicultural app have yet to be documented with respect to RDT in the nonfrancophone migrant population in France. Our goal was to design a multilingual app to overcome language barriers, health literacy barriers, and fears related to being tested to promote RDT of HIV, HBV, and HCV in the nonfrancophone migrant population in France. A combination of qualitative methods, agile development, and user-centered design was used. We conducted 2 focus groups (FGs) with 12 participants, including physicians, nurses, and social workers conducting RDT, as well as 1 modified Delphi survey with 68 participants including physicians and nurses. FGs explored the content (risk factors and medical history), functions (cultural adaptation and instant translation), and interface ergonomics (graphics and font) needed in the app. The Delphi presented 95 content items that the researchers sought to include in the app. Using FGs to inform the Delphi survey, we scientifically determined the app's content consisting of 95 items using expert consensus, developed a mock-up, and conducted initial user testing. We created an app that contains both migrant and clinician interfaces and includes a sociodemographic, risk assessment, health literacy, and testing barrier questionnaires available in 11 languages. Educational content is related to HIV, HBV, and HCV, along with the ability to understand whether the migrant agrees to be tested. This study allowed us to conceptualize a multilingual app that aims to increase the acceptance of RDT for HIV, HBV, and HCV. The specific features of the Assistant intelligent au dépistage des allophones app were designed to overcome the testing barriers in the nonfrancophone migrant population. The next phase will be an implementation study, as we intend to validate our app.

Development of Open Backend Structures for Health Care Professionals to Improve Participation in App Developments: Pilot Usability Study of a Medical App.

Efficient digitization in medicine still is in its infancy but undeniably has great potential for current and future challenges in health care. Thus far, the rollout of medical apps has not resulted in widespread use of smartphones in the German health care sector-the reasons for this have not been clarified so far. Nevertheless, the lack of user involvement in the development process and content creation might contribute to low acceptance of these products. This study aims to outline an approach to involve medical expertise without any coding knowledge for developing medical app content and functions. An end user-operable backend was built. Its usability was evaluated using a usability evaluation test protocol. The results of the usability tests were evaluated by the app development team, and the usability test was repeated for optimizing backend usability. In total, 40 criteria to measure the ease of app usage were defined a priori. The usability test comprised 20 tasks that had to be fulfilled. Usability tasks were analyzed for completion, dropout, and test duration. Due to the COVID-19 pandemic, digital videoconferencing platforms (Zoom and QuickTime Player) were used to complete usability questionnaires. Finally, several backend-based apps for several specialties (infectiology, plastic and reconstructive surgery, and orthopedics) were developed by health care professionals as prototypes. Initial usability testing was conducted with 5 participants (4 men and 1 woman; mean age 39.2, SD 5.97 years). All of them could complete the assigned backend tasks with only a few workflow interruptions and some minor errors. After usability optimization, the workflow completion time decreased from 5.03 minutes to 3.50 minutes, indicating a time saving. The basic backend structure was clear to all test users and the handling was intuitive to learn. Some minor errors in the backend occurred during the test rounds. The apps developed using the aforementioned approach are in clinical use as a proof of concept. Backends offering operability for medical professionals might have great potential for app development in the mobile health sector. Sophisticated and time-saving usability are pivotal for the acceptance of medical software, as illustrated by the backend-based apps presented herein, which are in clinical use as a proof of concept. Basic interventions are essential and sufficient for adequate usability optimization. Practicable, well-structured software usability evaluation is possible based on the usability evaluation test protocol.

An Online Acceptance and Mindfulness Intervention for Chronic Pain in Veterans: Development and Protocol for a Pilot Feasibility Randomized Controlled Trial.

In the veteran community, chronic pain is particularly prevalent and often debilitating. Until recently, veterans with chronic pain were offered primarily pharmacological intervention options, which rarely suffice and can also have negative health consequences. To better address chronic pain in veterans, the Veterans Health Administration has invested in novel, nonpharmacological behavior interventions that target both pain management and chronic pain-related functional issues. One approach, acceptance and commitment therapy (ACT) for chronic pain, is supported by decades of efficacy evidence for improving pain outcomes; however, ACT can be difficult to obtain owing to issues such as a lack of trained therapists or veterans having difficulty committing to the time and resources needed for the full clinician-led ACT protocol. Given the strong ACT evidence base combined with access limitations, we set out to develop and evaluate Veteran ACT for Chronic Pain (VACT-CP), an online program guided by an embodied conversational agent to improve pain management and functioning. The aims of this study are to develop, iteratively refine, and then conduct a pilot feasibility randomized controlled trial (RCT) of a VACT-CP group (n=20) versus a waitlist and treatment-as-usual control group (n=20). This research project includes 3 phases. In phase 1, our research team consulted with pain and virtual care experts, developed the preliminary VACT-CP online program, and conducted interviews with providers to obtain their feedback on the intervention. In phase 2, we incorporated feedback from phase 1 into the VACT-CP program and completed initial usability testing with veterans with chronic pain. In phase 3, we are conducting a small pilot feasibility RCT, with the primary outcome being assessment of usability of the VACT-CP system. This study is currently in phase 3; recruitment for the RCT began in April 2022 and is expected to continue through April 2023. Data collection is expected to be completed by October 2023, with full data analysis completed by late 2023. The findings from this research project will provide information on the usability of the VACT-CP intervention, as well as secondary outcomes related to treatment satisfaction, pain outcomes (pain-related daily functioning and pain severity), ACT processes (pain acceptance, behavioral avoidance, and valued living), and mental and physical functioning. ClinicalTrials.gov NCT03655132; https://clinicaltrials.gov/ct2/show/NCT03655132. DERR1-10.2196/45887.

Assessing the sustainability impacts of food sharing initiatives: User testing The Toolshed SIA

The food system is unsustainable and requires reconfiguration, however more data is required to assess the impacts of action which might contribute to a more sustainable food future. Responding to this, extensive research with food sharing initiatives—activities which have been flagged for their potential sustainability credentials—led to the co-design of an online sustainability impact assessment (SIA) tool to support food sharing initiatives to asses and evidence their sustainability impacts. This paper reports on the initial user testing of the resulting online tool: The Toolshed which forms the indicator based SIA element of the SHARE IT platform. Feedback gathered from the initiatives testing the tool are analyzed and summaries of their reported impacts detailed. This analysis confirms the need for the tool, the relevance of the indicators included and the value of SIA reports for internal reflection and external communication. Nonetheless, challenges remain in relation to resourcing the practice of SIA reporting. We conclude with a plan for expanding engagement with The Toolshed and the wider SHARE IT platform.

Design and Development of a qPCR-Based Mitochondrial Analysis Workflow for Medical Laboratories

Mitochondrial DNA (mtDNA) damage is closely associated with typical diseases of aging, such as Alzheimer’s or Parkinson’s disease, and other health conditions, such as infertility. This damage manifests in reduced mitochondrial copy number and deletion mutations in mtDNA. Consequently, the analysis of mitochondrial damage by determining the parameters copy number and deletion ratio using quantitative real-time PCR (qPCR) is of interest for clinical diagnostics. To bring the findings from research into laboratory practice, a suitable and reliable process is needed, which must be thoroughly validated. This process includes the software used for the analysis, which must meet extensive regulatory and process requirements. Existing software does not adequately implement the requirements of laboratories and, in particular, does not provide direct support for the calculation of the aforementioned mtDNA parameters. The paper discusses the development of a new software-based analysis workflow that is designed specifically for laboratories to help with the calculation of mtDNA parameters. The software was developed using the User-Centered Design method and is based on the recently introduced prototype, “PlateFlow”. Initial user tests provide positive feedback. In the future, this workflow could form the basis for validations of mitochondrial tests in medical laboratories.

Analysis of User Experience Online Mentoring Platform with User-Centered Design Approach at Giza Design Lab

Learning or virtual learning platforms are becoming more and more widespread in education during the COVID-19 epidemic since digital learning eliminates the time and distance barriers. Online learning through internet media is growing rapidly. There are several online learning applications during the pandemic. Giza online mentoring is one of the online platforms based on mentor systems. This study creates a Giza online coaching platform for UX design using the User Centered Design (UCD) methodology. The process included user research to build the empathize, design a prototype, and usability testing of the mentoring platform to validate the solution based on a user-centered approach. The prototype is tested with usability testing. Usability testing is used to evaluate the prototype. Twenty-eight people participated in the initial usability test with a maze design, and the findings showed that 25% of users bounced, 75% of users succeeded indirectly, and 0 individuals succeeded immediately. On the other hand, the second test demonstrates that the improvement results have a respectable impact on user experience, with 82.9 percent user indirect success, 17.1 percent bounce, and 0 users experiencing immediate success.

Usability and acceptability of a cognitive training intervention (SMART) for people with multiple sclerosis (MS): A prefeasibility formative evaluation.

Multiple sclerosis (MS) is a chronic autoimmune, inflammatory neurological disease of the central nervous system (CNS), increasing in incidence and prevalence across both developed and developing countries. Cognitive difficulties are common in MS sufferers with 70% experiencing difficulties in higher-level brain functioning such as planning, attention, problem solving, and memory. Computerised cognitive training programmes may hold promise as a treatment option for improving cognitive function in people with MS, subject to exploring and addressing potential barriers to usability and acceptability. This study aimed to test the usability and acceptability of a computerised cognitive training intervention-Strengthening Mental Abilities Through Relational Training (SMART) -for people with MS, through a mostly qualitative prefeasibility design ( n= 12). There were two phases of testing: (1) initial usability testing via a think-aloud protocol ( n= 6) and (2) alpha-testing to assess experienced acceptability over a four-week period of engagement ( n= 6). Data from the two phases were subjected to Framework Analysis, wherein we deductively applied the Health IT Usability Evaluation Model and Theoretical Framework of Acceptability to assess usability and acceptability, respectively. Results show SMART to have satisfactory usability with participants reacting positively to the formatting, visuality, and process of the interface. Minor suggestions were made on how best to adapt SMART for people with MS, but the programme and facilitative support were generally perceived to be acceptable, with participants expressing positive feelings about taking part in the intervention, despite associated burdens. This prefeasibility study provides preliminary evidence of the usability and acceptability of SMART as a computerised cognitive training programme for people with MS. We conclude that we can now move forward with a feasibility trial of SMART, with the intention of proceeding to a definitive trial with cost-effectiveness analysis.

Understanding the needs of people aging with type 1 diabetes: a user-focused research study with prototype diabetes advance directive and setting the stage for future research

PurposePeople living with Type 1 diabetes (T1D) are living longer than ever and facing the new “luxury” of the challenges of aging. While research is slowly expanding and addressing T1D physiology with regards to aging, there is little research addressing specific challenges and barriers to optimal care by those aging with T1D. To address this gap, this study employed human-centered design research to explore the gaps and barriers to care faced by people aging with T1D.MethodsResearchers employed human-centered design methods of needfinding and user interviews and facilitated participatory workshops. In total, 27 people with T1D (PWT1D), 5 loved ones (partners of PWT1D), and 7 healthcare providers (HCPs) were engaged.ResultsDesign artifacts were developed, including user personas that help visually articulate the different experiences of PWT1D and their unique needs as they age, as well as a prototype diabetes-specific advance directive that could be further refined to specifically aid those with Type 1 diabetes who are aging and requiring more interactions with the healthcare system. Initial user testing with people with T1D as well as healthcare providers demonstrated the need for such a diabetes advance directive tool or document.ConclusionThis work supports the conclusion that additional focus and scientific enquiry should be given to the needs of people aging with Type 1 diabetes, with a goal of improving the experience of all people with T1D when interacting with their care providers or with the healthcare system as a whole.

A Social Virtual Reality Mobile Application for Learning and Practicing English

Many studies promise that virtual reality (VR) applications will be one of the most used tools in foreign language learning. This is because VR keeps learners engaged, motivated, and prepared with better communication skills due to the simulation of real-life environments. As a result of the COVID-19 pandemic and social distancing, it became difficult to use and practice newly learned language skills with real people directly. This paper proposes a social VR mobile application that can be used anytime anywhere to offer a set of different VR environments that simulate real-life situations in order to learn and practice the English language. The application aims to improve speaking skills by offering a private session with a native speaker tutor or a community of learners to practice speaking. It combines the benefits of mobile learning, social networks, and VR. Initial usability testing results showed that the application is simple and easy to use, with some problems discovered and resolved. The application demonstrates that applying VR tools could contribute positively to learning English among the language learners using it.

Acceptability of an mHealth App for Youth With Substance Use and Mental Health Needs: Iterative, Mixed Methods Design.

BackgroundTreating substance use disorders (SUDs) during adolescence can prevent adult addiction and improve youth outcomes. However, it can be challenging to keep adolescents with SUDs engaged in ongoing services, thus limiting potential benefits. Developmentally appropriate tools are needed to improve treatment engagement during and between sessions for youth with SUDs and mental health disorders. Mobile health apps may augment or replace psychotherapy components; however, few have been developed specifically for youth with SUDs following user-guided design principles, which may limit their appropriateness and utility. Formative research on acceptability to intended end users is needed before the efficacy of such tools can be examined.ObjectiveThis study involves user-centered, iterative development and initial user testing of a web-based app for adolescents with SUDs and mental health concerns.MethodsAdolescents aged 14 to 17 years with past-year involvement in outpatient psychotherapy and behavioral health clinicians with adolescent SUD treatment caseloads were recruited. Across 2 assessment phases, 40 participants (alpha: 10 youths and 10 clinicians; beta: 10 youths and 10 clinicians) viewed an app demonstration and completed semistructured interviews and questionnaires about app content and functionality.ResultsParticipants expressed positive impressions of the app and its potential utility in augmenting outpatient therapy for youth with SUDs and mental health concerns. Noted strengths included valuable educational content, useful embedded resources, and a variety of activities. Adolescents and clinicians favored the app over conventional (paper-and-pencil) modalities, citing convenience and familiarity. The app was found to be user-friendly and likely to improve treatment engagement. Adolescents suggested the inclusion of privacy settings, and clinicians recommended more detailed instructions and simplified language.ConclusionsThe novel app developed here appears to be a promising, acceptable, and highly scalable resource to support adolescents with SUDs and mental health concerns. Future studies should test the efficacy of such apps in enhancing adolescent behavioral health treatment engagement and outcomes.

Visualizing the terror threat

Terrorism represents one of the most pressing contemporary security threats. As a consequence, governments provide information to the public on threat levels and on how to respond to terror incidents. To effectively reassure the public, and to increase their vigilance, it is essential that the information communicated is accessible, clear, actionable and engaging. This is the first empirical study in the world to explore the impact of information design principles and visualization of information on the communication of security information related to terrorism. Two different but complementary strands were devised: Strand 1 - compared whether more visualized information was more effective than text dense information at communicating to the public; Strand 2 - compared whether a motion graphics was more effective than an infographic at communicating to the public. An initial usability test was conducted to identify existing problems and needs. Several other usability tests and iterations were then conducted to develop new design solutions. Empirical testing was then conducted for final evaluation and validation, collecting quantitative and qualitative data. Results show significant differences between pre- and post-knowledge of the Terror Threat Levels. Results also show significant differences between text dense information and more visualized information. Results further show no significant difference between communicating information via an infographic or motion graphics in situations where information needs to be assimilated as a crescendo (i.e. levels of severity) or as a series of steps to be followed (action in an emergency). This study provides important guidelines on how to effectively communicate security information to the public, with practical implications for security agencies.

Shared decision making in pregnancy in inflammatory bowel disease: design of a patient orientated decision aid

BackgroundResearch has indicated a lack of disease-specific reproductive knowledge among patients with Inflammatory Bowel Disease (IBD) and this has been associated with increased “voluntary childlessness”. Furthermore, a lack of knowledge may contribute to inappropriate medication changes during or after pregnancy. Decision aids have been shown to support decision making in pregnancy as well as in multiple other chronic diseases. A published decision aid for pregnancy in IBD has not been identified, despite the benefit of pre-conception counselling and patient desire for a decision support tool. This study aimed to develop and test the feasibility of a decision aid encompassing reproductive decisions in the setting of IBD.MethodsThe International Patient Decision Aid Standards were implemented in the development of the Pregnancy in IBD Decision Aid (PIDA). A multi-disciplinary steering committee was formed. Patient and clinician focus groups were conducted to explore themes of importance in the reproductive decision-making processes in IBD. A PIDA prototype was designed; patient interviews were conducted to obtain further insight into patient perspectives and to test the prototype for feasibility.ResultsIssues considered of importance to patients and clinicians encountering decisions regarding pregnancy in the setting of IBD included fertility, conception timing, inheritance, medications, infant health, impact of surgery, contraception, nutrition and breastfeeding. Emphasis was placed on the provision of preconception counselling early in the disease course. Decisions relating to conception and medications were chosen as the current focus of PIDA, however content inclusion was broad to support use across preconception, pregnancy and post-partum phases. Favourable and constructive user feedback was received.ConclusionsThe novel development of a decision aid for use in pregnancy and IBD was supported by initial user testing.

The more the merrier! Barriers and facilitators to the general public’s use of a COVID-19 contact tracing app in New Zealand

ABSTRACT Contact tracing for infectious diseases can be partially automated using mobile applications. However, the success of these tools is dependent on significant uptake and frequent use by the public. This study explored the barriers and facilitators to the New Zealand (NZ) general public’s use of the COVID-19 contact NZ COVID Tracer app. Adults (≥18 years, N = 373) in NZ. Qualitative and quantitative data were gathered from a nation-wide online survey. App use and frequency of use were presented as descriptive statistics. Qualitative data were analyzed thematically. 31% reported using the app frequently, 24% used it sometimes, 21% had installed but not used it, and 24% had not installed it. Barriers to use include technical issues, privacy and security concerns, forgetfulness and a lack of support from businesses. The perceived risk of contracting COVID-19, government recommendations and communications, and the importance of contact tracing facilitated use. Technical, user, business, and government factors influenced the public’s use of a COVID-19 contact tracing app. The development of apps requiring minimal user effort and initial user testing may improve uptake. Enabling environments and better risk communication may improve uptake of similar community-driven contact tracing apps during future pandemics.

Development of a digital toolkit to improve quality of life of patients with systemic lupus erythematosus.

ObjectiveThe purpose of this manuscript is to detail development and initial usability testing of an e-toolkit designed to provide skills and knowledge around self-management behaviors for individuals living with systemic lupus erythematosus.MethodsResearchers worked with a steering committee of patients and providers to (1) develop a clickable prototype of an e-toolkit and (2) conduct alpha (individuals not affiliated with an academic clinic as patient or provider) and beta (individual patients with systemic lupus erythematosus as well as members of the clinic healthcare team and individuals who work in patient advocacy organizations) usability testing through semistructured interviews.ResultsDuring the review of the e-toolkit, the feedback provided by participants in both alpha and beta groups centered on two overarching themes: (1) improving user interface and materials and (2) integration of information and supports between toolkit and clinical personnel.ConclusionDigital approaches that are tailored to individual symptom variation and integrated with a clinical system have the opportunity to enhance ongoing clinical care. These findings support movement toward integrated, team-based care models, tailored digital resources, and use of expanded virtual interaction options to ensure on-going engagement between healthcare providers and systemic lupus erythematosus patients.

Qualitative Evaluation of a Novel Educational Tool to Communicate Individualized Hip Fracture Prognostic Information to Patients and Surrogates: My Hip Fracture (My-HF).

IntroductionMortality and morbidity are high for older adults after hip fracture (HF), but patients and surrogate decision makers (SDMs) are typically unaware of the poor prognosis. We developed a novel educational tool, My Hip Fracture (My-HF), to provide patients and SDMs of patients hospitalized with acute HF individualized estimates of their post-HF prognosis. We conducted initial usability testing of My-HF in a sample of patients with HF and SDMs.Materials and MethodsMy-HF provides information about: 1) anatomy and risk factors for HF; 2) Hip fracture treatment received; 3) individualized predicted risk of adverse events and 4) anticipated discharge trajectory. We conducted a qualitative usability study using a convenience sample of hospitalized, post-operative patients with acute HF or SDMs of patients who lacked decision-making capacity. We used semi-structured interviews to obtain feedback. Thematic analysis was used to identify themes and concepts.ResultsWe conducted interviews with 8 patients and 9 SDMs (mean age of interviewees 70.1 years, 41% female). My-HF was generally well received. Thematic analysis identified legibility and visual appeal, comprehension, numeracy, utility and reflection as prominent themes. Most respondents found My-HF to be useful in improving their understanding of HF and as a potential mechanism for sharing information with other care team members (including family and professionals). Suggestions for improvement of legibility, presentation of the individualized prognosis information and content were identified.DiscussionPatients and SDMs are generally accepting of My-HF and found it useful for communicating individualized prognostic information. Feedback identified areas for improvement for future iterations of the tool.ConclusionMy-HF presents a means of addressing the gap in understanding of prognosis post-HF as a part of patient-centered care. Further evaluation will be needed to assess the impact of My-HF on patient and SDM reported outcomes as we transition from a paper to smart-phone enabled web application.

A Novel Educational Prescription Web-Based Application to Support Education for Caregivers of People Living With Dementia: Development and Usability Study With Clinicians.

BackgroundIt is estimated that 564,000 Canadians are currently living with dementia and there are approximately 486,000 to 1.1 million informal family/friend caregivers. Family/friend caregivers often receive little to no education or training about dementia but are expected to provide ongoing support for a complex condition. Web-based family/friend caregiver interventions may be helpful, but little is known about how best to implement them.ObjectiveThe objectives of this study were to 1) design and develop a novel education prescription application to help scale and spread web-based dementia education to family/friend caregivers, 2) conduct user testing, and 3) conduct a larger-scale field trial.MethodsA novel education prescription web-based application was designed and developed. Initial user testing used task completion and the “think aloud” technique with a small sample of representative clinicians who work with people living with dementia and family/friend caregivers. Following iterative incorporation of feedback, a larger field trial was conducted with a convenience sample of clinicians. Account invitations were sent to 55 clinicians and, following a 2-month trial period, surveys were administered to participants including the System Usability Scale and the Net Promoter Score.ResultsDuring the initial user testing phase, participants (N=7) from representative disciplines easily completed associated tasks, and had very positive feedback with respect to the usability of the application. The System Usability Scale score during this phase was 91.4. Suggestions from feedback were incorporated into the application. During the larger field trial phase, participants (total N=55; activated account n=17; did not activate account n=38) were given access to the iGeriCare education prescription application. During this period, 2 participants created educational prescriptions; a total of 3 educational prescriptions were sent. Survey completers who did not activate their account (n=5) identified that their lack of use was due to time constraints, competing priorities, or forgetting to use the application. Survey completers who activated their account (n=5) identified their lower use was due to lack of time, lack of eligible family/friend caregivers during trial period, and competing priorities due to the COVID-19 pandemic. The System Usability Scale score during this phase was 78.75, and the Net Promoter Score was 50.ConclusionsStudy findings indicate a generally positive response for the usability of a web-based application for clinicians to prescribe dementia education to family/friend caregivers. The dissonance between the promising data and widespread enthusiasm for the design and purpose of the education prescription application found in the initial user testing phase and subsequent lack of significant adoption in the field trial represents both an important lesson for other novel health technologies and a potential area for further investigation. Further research is required to better understand factors associated with implementation of this type of intervention and impact on dissemination of education to family/friend caregivers.