Target End Users Research Articles

Feasibility of Implementing the STEADY Wellness Program to Support Hospital Staff During the COVID-19 Pandemic

Introduction:The COVID-19 Pandemic negatively impacted the mental wellbeing of healthcare workers worldwide. Many organizations responded reactively to their staff needs. The novel, evidence-informed Social Support, Tracking Distress, Education and Discussion Community (STEADY) program was implemented, with senior leadership support across a large hospital. STEADY is a multi-pronged program developed to mitigate occupational stress injury in healthcare workers and first responders. This project examined the feasibility of implementing STEADY across hospital units during a pandemic.Method:STEADY was implemented in five acute care units and across the rehab site of a large hospital. Data was collected on the five program components (drop-in peer support groups and critical incident debriefs, psychoeducation workshops, wellness assessments, peer partnering, community-building initiatives). Most peer support groups were facilitated by the program manager trained in peer support and one of six clinical staff.Results:The program was iteratively adapted to meet the needs of target units/groups. More than 300 sessions were run in ~one year, for an average of ~1.15 sessions per unit per week. With flexible adaptation to the mode of facilitation, ~75% of planned workshops and ~85% of peer support sessions were run. Three critical incident stress debriefs were held. The formal partnering program was offered via e-mail with minimal uptake. Ninety-five wellness assessments were completed by target end-users, with 36 personalized responses sent. Gratitude trees were posted in each unit for community-building. Eight target unit staff completed formal peer support facilitation training. Twenty additional groups across the organization requested STEADY programming support and ten requested gratitude trees.Conclusion:Results indicate that most components of the STEADY program were feasible to implement in hospital units during the pandemic. On-site, interactive programming was most engaging for end-users. Leadership support and flexible, continuous adaption by program leaders were identified as facilitators to program implementation and uptake.

449 Multidisciplinary deprescribing review for frail older adults in long-term care: Development of a theory informed implementation strategy using a Delphi survey and Roundtable discussion with stakeholders

Abstract Introduction Deprescribing, the systematic process of stopping or altering inappropriate medicines, has been suggested as a safe, effective and appropriate process to optimise prescribing for older adults (1). There is still a lack of understanding of how best to implement sustainable deprescribing in long-term care (LTC). Aim Design a theory-driven implementation strategy, based on consensus from healthcare professionals (HCPs), to facilitate their engagement with deprescribing for frail older adults in LTC. Methods This study consisted of three phases and was designed in conjunction with HCPs working in LTC. Firstly, barriers and enablers to deprescribing in LTC previously identified by the research team were mapped to behaviour change techniques (BCTs) (2). Secondly, a Delphi survey of HCPs (General Practitioners (GPs), Pharmacists, nurses, geriatricians and psychiatrists of old age) was conducted to select feasible BCTs to support deprescribing. HCPs were purposively sampled and recruited via email, divided into HCPs working in Ireland and internationally. Experts were identified from existing professional relationships, engagement with LTC or deprescribing research. Using the results from the Delphi process, the literature on deprescribing interventions and research team knowledge, the BCTs which could form components of an intervention in LTC were shortlisted based on was acceptability, effectiveness, affordability, safety and equity (APEASE). Finally, a roundtable discussion was held with a purposeful, convenience sample of GPs, Pharmacists and nurses working in LTC in Ireland, to prioritise the previously identified barriers/enablers and operationalise the proposed deprescribing strategies created from feasible BCTs and identify the most important strategy to facilitate deprescribing. Results Overall, 34 BCTs were mapped to previously identified barriers/enablers to deprescribing in LTC. For the Delphi survey, 33 HCPs were invited, 20 agreed and it was completed by 16 participants. The Delphi consisted of two rounds. Participants reached consensus that 26 of the BCTs could feasibly be implemented in LTC. Following the APEASE assessment, 21 BCTs were considered eligible for operationalisation. The roundtable discussion, consisting of eight HCPs, identified that lack of resources (time, staffing, technology), was the most important barrier to address. The agreed implementation strategy to enhance engagement with deprescribing processes was an education session prior to a multidisciplinary team (MDT) meeting, led by a nurse from the LTC setting. This was designed from 11 BCTs, including action planning, social support and environmental restructuring addressing the predominant barrier. Incorporating the MDT reduces the burden which would exist if the responsibility was placed on one HCP. Meeting at the LTC site addresses the insufficient technology, as patient information is available. Conclusion This study describes an implementation strategy design process following principles of behavioural and implementation science. Engaging targeted end users throughout the process allows for the creation of a strategy which is intended to address the main perceived barrier to deprescribing of insufficient resources. A limitation of this study is the specificity of the intervention for Irish LTC context, which may have different staffing and organisational structures compared to international healthcare systems.

2021 CLINICAL PRACTICE GUIDELINES IN THE EVALUATION AND MANAGEMENT OF PEDIATRIC COMMUNITY-ACQUIRED PNEUMONIA

The Clinical Practice Guidelines (CPG) for the Diagnosis and Management of Pediatric Community-Acquired Pneumonia (PCAP) was initiated by the Philippine Academy of Pediatric Pulmonologists, Inc. (PAPP) and the Pediatric Infectious Disease Society of the Philippines (PIDSP), in cooperation with Philippine Pediatric Society, Inc. (PPS) way back in 2004. Several CPG updates were then undertaken by the PAPP PCAP CPG Task Force from 2008 to 2016. Clinically-relevant research questions were answered with recent and current recommendations based on evidence from local and international data. The 2021 PCAP CPG initiative was envisioned in March 2018 upon the recommendations of the 2018 PAPP Board for the purpose of updating the evidence in the PCAP CPG 2016 clinical questions. This led to the collaboration of PAPP and PIDSP to develop this CPG. Individual members were identified from each society as content experts to form the Steering Committee along with a clinical epidemiologist and technical writer as review experts. The committee identified the scope and target end user of the CPG as well as additional clinical questions to be included in the 2021 update aside from the questions on the previous CPGs. Selected members from the two societies formed the Technical Working Group (TWG) who did the literature search, appraisal of evidences, and formulation of recommendations. These recommendations were then presented to the stakeholders who became part of the consensus panel. There was no identified conflict of interest among the CPG developers, TWG members and stakeholders. A survey to determine potential competing interests were conducted during the development of this CPG. This initiative was fully funded by the PAPP and PIDSP societies. The 2021 PCAP CPG significantly differs from the previous CPGs in several aspects. First, the current guideline is a consensus between two pediatric societies. Second, much of the literature review has been centered on meta-analyses or systematic reviews instead of individual studies. Finally, appraisal of published literature was based on Grading of Recommendations, Assessment, Development and Evaluation (GRADE) criteria. Such methodological differences may provide difficulties in defining evolution of care through the years.

Securing and managing healthcare data generated by intelligent blockchain systems on cloud networks through DNA cryptography

PurposeThe purpose of this paper is to ensure the anonymity and security of health data and improve the integrity and authenticity among patients, doctors and insurance providers. Simulation and validation algorithms are proposed in this work to ensure the proper implementation of the distributed system to secure and manage healthcare data. The author also aims to examine the methodology of Wireless Body Area Networks and how it contributes to the health monitoring system.Design/methodology/approachWireless Body Area Network (WBAN) plays an important role in patient health data monitoring. In this paper, a novel framework is designed and proposed to generate data by the sensor machines and be stored in the cloud, and the transactions can be secured by blockchain. DNA cryptography is used in the framework to encrypt the hashes of the blocks. The proposed framework will ensure the anonymity and security of the health data and improve the integrity and authenticity among the patients, doctors and insurance providers.FindingsCloud Computing and Distributed Networking have transformed the IT industry and their amalgamation with intelligent systems would revolutionize the Healthcare Industry. The data being generated by devices is huge and storing it in the cloud environment would be a better decision. However, the privacy and security of healthcare data are still a concern because medical data is very confidential and desires to be safe and secure. The blockchain is a promising distributed network that ensures the security aspect of the data and makes the transactions authentic and transparent. In this work, the data is collected using various sensor devices and is transmitted to the cloud through the WBAN via the blockchain network.Research limitations/implicationsIn this paper, a framework for securing and managing the healthcare data generated by intelligent systems is proposed. As the data generated by these devices are heterogeneous and huge in nature, the cloud environment is chosen for its storage and analysis. Therefore, the transactions to and from the cloud are secured by using the blockchain-based distributed network.Practical implicationsThe target end-users of our system are the patients to keep themselves informed and healthy, healthcare providers to monitor the conditions of their patients virtually, and the health insurance providers to have a track of the history of the patients, so that no fraudulent claims can be made.Originality/valueThe target end-users of our system are the patients for keeping themselves informed and healthy, healthcare providers for monitoring the conditions of their patients virtually and the health insurance providers to have a track of the history of the patients, so that no fraudulent claims can be made.

Co-Creating Injury Prevention Education And Training For Youth Handball Players Targeting End-Users At The Individual, Team And Organizational Levels

Co-Creating Injury Prevention Education And Training For Youth Handball Players Targeting End-Users At The Individual, Team And Organizational Levels

Explainable AI tools for legal reasoning about cases: A study on the European Court of Human Rights

In this paper we report on a significant research project undertaken to design, implement and evaluate explainable decision-support tools for deciding legal cases. We provide a model of a legal domain, Article 6 of the European Convention on Human Rights, constructed using a methodology from the field of computational models of argument. We describe how the formal model has been developed, extended and transformed into practical tools, which were then used in evaluation exercises to determine the effectiveness and usability of the tools. The underpinning AI techniques used yield a level of explanation that is firmly grounded in legal reasoning and is also digestible by the target end users, as demonstrated through our evaluation activities. The results of our experimental evaluation show that on the first pass, our tool achieved an accuracy rate of 97% in matching the actual decisions of the cases and the user studies conducted gave highly encouraging results with respect to usability. As such, our project demonstrates how trustworthy AI tools can be built for a real world legal domain where critical needs of the end users are accounted for.

The Acceptability of Using Augmented Reality as a Mechanism to Engage Children in Asthma Inhaler Technique Training: Qualitative Interview Study With Deductive Thematic Analysis.

Inhaled medications or inhalers provide first-line pharmacotherapeutic treatment for patients with asthma for both acute symptomatic relief and long-term management to keep symptoms under control. A good technique requires only basic instruction and training; however, a recent study identified that 92% of children do not follow all correct steps when using inhalers. There is a growing interest in technology-enhanced asthma education, with evidence demonstrating improvements in knowledge and treatment adherence. Subsequently, there are calls to explore the role of technology-based solutions in improving asthma management and disease outcomes from public health experts, health professionals, and patients with asthma. Augmented reality (AR) technology is an information delivery mechanism with proven efficacy in educational settings. AR displays digital content in a real-world environment using the camera on a smartphone or tablet device to create an immersive learning experience. The study aimed to evaluate the acceptability of AR as a mechanism for delivering asthma inhaler technique education from the perspective of children with asthma and their parents and health professionals, examined through the theoretical framework of acceptability (TFA). An asthma education resource enhanced with AR technology was created to provide inhaler technique education to children. An iterative co-design process was undertaken with target end users for a qualitative evaluation. The participants were 8 to 12 years old with asthma, their caregivers, and health professionals who had experience in managing asthma. Qualitative data were obtained through semistructured one-on-one interviews. Deductive thematic analysis using TFA was undertaken using NVivo software 2020 to assess the acceptability of AR as a delivery modality for asthma inhaler technique education. Overall, 6 health care professionals, 5 asthmatic children, and 5 caregivers of children with asthma totaled a sample of 16. The use of AR in the asthma inhaler resource was found to be acceptable when responses were examined in accordance with TFA. Each of the 7 component constructs of TFA was coded throughout the 16 interviews, with perceived effectiveness (157 times) and affective attitude (63 times) coded most frequently. Positive responses included the intervention being accessible, easy to use, interesting, and fitting within the users' value systems. Negative responses included the need to maintain an interest in children and concerns about the loss of face-to-face interaction with health professionals. AR appears to be an acceptable modality for delivering asthma education to children when explored using TFA constructs. Although some challenges were identified with the use of AR, the results were predominantly positive. Future designs of asthma education interventions involving AR should consider the results of this study, and further research should focus on the feasibility, usability, and barriers and facilitators of behavior change to ensure the successful implementation and uptake of AR into clinical settings. RR2-10.1177/16094069211042229.

The potential of mHealth for older adults on dialysis and their care partners: What's been done and where do we go from here?

Self-care, or the dynamic, daily process of becoming actively involved in one's own care, is paramount to prevent and manage complications of end-stage kidney disease. However, many older dialysis patients face distinctive challenges to adequate engagement in self-care. One promising strategy for facilitating self-care among older dialysis patients and their care partners is the utilization of mobile health (mhealth). mHealth encompasses mobile and wireless communication devices used to improve healthcare delivery, patient and care partner outcomes, and patient care. In other disease populations, mHealth has been linked to maintenance of or improvements in self-management, medication compliance, patient education, and patient-provider communication, all of which can slow disease progression. Although mHealth is considered feasible, acceptable, and clinically useful, this technology has predominately targeted younger patients. Thus, there is a need to develop mHealth for older dialysis patients and their care partners. In this article, we describe current mHealth usage in older dialysis patients, including promising findings, challenges, and research gaps. Given the lack of research on mHealth among care partners of older dialysis patients, we highlight lessons learned from other disease populations to inform the future design and implementation of mHealth for these key stakeholders. We also propose that leveraging care partners represents an opportunity to meaningfully tailor mHealth applications and, by extension, improve care partner physical and mental health and decrease caregiver burden. We conclude with a summary of future directions to help older dialysis patients and their care partners receive recognition as target end-users amid the constant evolution of mHealth.

End-user research in support of long-acting systemic antiretroviral delivery systems: insights from qualitative research with providers and target users in South Africa

While oral pre-exposure prophylaxis (PrEP) has been shown to reduce the risk of HIV, challenges such as adhering to a daily-dosing regimen and persistence have emerged as barriers for at-risks populations in South Africa. This qualitative research sought to investigate perceptions of and preferences for a long-acting, biodegradable implantable PrEP product designed to address these barriers. To identify and understand motivators, barriers, and preferences for the PrEP implant, we conducted qualitative in-depth interviews (IDIs) among health care providers (HCPs) and target end-users (young women, adolescent girls, and female sex workers) in urban and rural/peri-urban regions of Gauteng Province, South Africa. The IDIs focused on defining values, beliefs, habits, lifestyles, influencers, and information channels for potential PrEP implant end-users. We conducted 36 IDIs across health care providers and target end-user respondent segments. Respondents had generally positive reactions to the PrEP implant. Most end-users felt that some undesirable aspects of the implant (e.g., side effects, pain during insertion, potential scarring, and inability to removeimplant) would be offset by having a highly effective, and long-lasting HIV prevention product. Although some HCPs believed the implantable PrEP would lead to increases in promiscuity and risky sexual behavior, most HCPs saw value in the PrEP implant's long duration of protection, its biodegradability, and the likelihood of higher adherence relative to oral PrEP. This study is a first step toward further research needed to demonstrate the demand for a biodegradable, long-acting implantable PrEP and suggests such a product would be accepted by end-users and HCPs in South Africa. This study indicates the need to develop more convenient, discreet, long-acting, and highly effective biomedical HIV prevention options for at-risk populations.

Influence of different extraction methods on the chemical composition, antioxidant activity, and overall quality attributes of oils from Trichosanthes kirilowii Maxim seed

Trichosanthes kirilowii Maxim seed oil is full of nutrition and exerts positive effects on the health of humans. The study detected and compared the quality characteristics, the lipid composition and active constituents of Trichosanthes kirilowii Maxim seed kernel and shell oil. This study used four extraction techniques: cold pressing, ultrasonic-assisted solvent extraction, supercritical fluid extraction, and subcritical butane extraction. The results indicated that the highest lipid yield (36.75%) was obtained by ultrasonic-assisted solvent extraction, while the lowest (32.24%) was obtained by supercritical fluid extraction. Meanwhile, Trichosanthes kirilowii Maxim seed oil is rich in linoleic acid (25.64–31.24%) and α-tocopherol (247.76–702.28 mg/kg). The extraction method and shells significantly affected beneficial phytochemicals (tocopherols, phytosterols and total phenols) and antioxidant activity (DPPH) (p < 0.05). Moreover, the tocopherols of supercritical fluid extraction oil (1020.15–1052.55 mg/kg) and the phytosterols of cold pressing oil (1033.84–1748.20 mg/kg) were higher than that of other methods under the same conditions. The content of sterols and tocopherol in the seed kernel oil is higher than that of the seed shell oil. Meanwhile, cold pressing oil had more abundant volatile compounds. The above information is valuable for manufacturers to select the appropriate method to produce Trichosanthes kirilowii Maxim seed oil with the desired quality attributes and chemical compositions for the target end-user.

A human mesenchymal spheroid prototype to replace moderate severity animal procedures in leukaemia drug testing

Patient derived xenograft (PDX) models are regarded as gold standard preclinical models in leukaemia research, especially in testing new drug combinations where typically 45-50 mice are used per assay. 9000 animal experiments are performed annually in the UK in leukaemia research with these expensive procedures being classed as moderate severity, meaning they cause significant pain, suffering and visible distress to animal’s state. Furthermore, not all clinical leukaemia samples engraft and when they do data turnaround time can be between 6-12 months. Heavy dependence on animal models is because clinical leukaemia samples do not proliferate in vitro. Alternative cell line models though popular for drug testing are not biomimetic – they are not dependent on the microenvironment for survival, growth and treatment response and being derived from relapse samples they do not capture the molecular complexity observed at disease presentation. Here we have developed an in vitro platform to rapidly establish co-cultures of patient-derived leukaemia cells with 3D bone marrow mesenchyme spheroids, BM-MSC-spheroids. We optimise protocols for developing MSC-spheroid leukaemia co-culture using clinical samples and deliver drug response data within a week. Using three patient samples representing distinct cytogenetics we show that patient-derived-leukaemia cells show enhanced proliferation when co-cultured with MSC-spheroids. In addition, MSC-spheroids provided improved protection against treatment. This makes our spheroids suitable to model treatment resistance – a major hurdle in current day cancer management Given this 3Rs approach is 12 months faster (in delivering clinical data), is a human cell-based biomimetic model and uses 45-50 fewer animals/drug-response assay the anticipated target end-users would include academia and pharmaceutical industry. This animal replacement prototype would facilitate clinically translatable research to be performed with greater ethical, social and financial sustainability.

Intra-City Traffic Data Visualization: A Systematic Literature Review

The increasing proportion of people living in urban areas causes well-known mobility issues such as pollution and congested roads. In addition to their heavy environmental impact, these issues negatively affect citizens’ quality of life. Emerging technologies allow gathering huge amounts of data regarding traffic which can in turn be analyzed to diagnose mobility issues and propose solutions. Information visualization is increasingly leveraged as a medium to make the most out of this traffic data. In this paper, we present the systematic literature review we conducted to analyze the existing research in intra-city traffic data visualization. Following a well-defined and rigorous protocol, we have made a selection of 146 relevant works which we analyzed in depth under multiple perspectives: the data used, the domain problems, the visualization techniques and interaction, and the target end-user. We were able to identify common practices such as the most used visualization techniques and the problems tackled the most often. This allowed us to uncover little explored research directions and to suggest avenues for innovative research. In particular, we noted a lack of visualizations engaging citizens in the reflection on mobility-related issues and a lack of consideration for user studies.

Ground-based investigation of a directional, flexible, and wireless concentrated solar energy transmission system

Solar energy in space is more intensive and continuous compared to that on the Earth, and thus, is encouraged by governments across the world to be utilized for human beings. The continuity of the space sunlight has a great potential to overcome the bottleneck of the variability and intermittency in time and space for ground-based solar energy applications. Space solar power station (SSPS) is known as intermedia that can harvest the space solar energy and transmit it wirelessly to the end-user. However, the current wireless energy transmission via microwave or laser suffers from low energy transmission efficiency because of excessive energy conversion processes. Wireless energy transmission via sunlight without any intermediate energy conversion process was proposed previously theoretically for high energy transmission efficiency, but it also lacks practicability due to heavyweight and inflexibility. Therefore, although promising, practical sunlight-based wireless energy transmission proposals have not ever been presented. Here, through component and structure optimizations in theoretical and experimental approaches, a novel and more practical concentrated solar energy wireless transmission system that transmits the harvested sunlight via lightweight optical fibers is proposed in this paper. It uses a Fresnel lens to collect concentrated solar energy and then, the utilized optical fiber can steer the collected energy to the collimator flexibly. At last, a parallel sunlight beam can be emitted from the collimator to the target end-user. Results show that the transmitter efficiency versus optical fiber length exhibited a linear relationship from both theoretical and experimental approaches. the cloud effect harmed the energy transmission. A maximum transmitter energy transmission efficiency of 52.0% could be attained experimentally. Compared with the performance in the no-cloud condition, the gained voltage could be declined by 37% ∼ 48%. The bending of the optical fiber seemed to not affect much on the energy transmission performance, which guarantees a flexible energy transmission. Besides, the power/weight ratio was increased by 17.0% compared to its counterpart. The innovation of this paper is to reduce the gap between theoretical and practical feasibilities for the proposed system. This paper experimentally demonstrates the feasibility of a wireless concentrated solar energy transmission technology, which promotes the application of SSPS and related aerospace applications.

User-Centered Design of a Mobile Application to Improve Healthy Food Availability in Under-Resourced Urban Settings

ObjectivesSmall independently-owned corner stores located in under-resourced urban settings typically lack affordable, high-quality fresh foods. To address gaps identified in the supply-side procurement and distribution of healthier foods to corner stores, we developed the Baltimore Urban food Distribution (BUD) mobile application (app). The app works to move healthier foods from local suppliers to corner stores via collective purchasing and shared delivery. Here we characterize the usability, acceptability, and functionality of the BUD app based on mixed-methods formative research. MethodsFormal and informal in-depth interviews were conducted across multiple stages of the development of the app, leading to iterative improvements. Usability testing included app prototype demonstrations and task completion as part of a user-centered design process—with a strong emphasis on target end-users and their needs—among relevant stakeholders (consumers, retailers, suppliers, community- and government-level organizations). An initial pilot of a simplified version of the app was then conducted among one produce supplier and two corner stores in East Baltimore from December 2021 to February 2022. ResultsStakeholders found the BUD app to have high usability, acceptability, and functionality. Interviews revealed that corner store owners would like to see a wide array of products available on the app, and suppliers felt the app could allow them to create a new market for their products. Other stakeholders saw potential for future expansion of the app to other hard-to-reach settings (schools, rural communities). Usability testing informed refinement of app features such as product uploading, delivery and payment options. Our initial pilot demonstrated a need to build rapport, trust, and store owner self-efficacy when first introduced to the app. ConclusionsSupply-side barriers to healthy eating are often overlooked and there is a major gap in connectivity between local suppliers and small store owners. The BUD app aims to provide a digital solution to address this in an under-resourced urban setting. Future research will entail scale-up of the app, allowing us to explore how BUD can sustainably strengthen the relationships between different actors of the food system and their complex, dynamic food environments. Funding SourcesNHLBI, NIH, R34HL145368.

The researcher's lament: Why do they ignore my science?

AbstractThe researcher's lament is shared by many environmental and conservation scientists who complain about the little support they receive for their research proposals during the review and selection process. Understandably, any hopes of having their anticipated scientific findings applied toward the formulation of environmental management decisions or natural resource policy action are shattered. They attribute this lack of endorsement to shortcomings and limitations among decision makers and proposal selection officials when, in many cases, the rejection of project proposals is often a function of a handful of self‐inflicted failures by applied scientists who anchor themselves stubbornly to doomed approaches. Familiar deficiencies in their research proposals perpetuate the disconnect between the enterprise of science and real‐world resource management challenges. Researchers themselves can affect conditions that turn up the appetite for their scientific endeavors as a more meaningful component of the decision‐making process, namely, to stage and deliver science that is more readily “actionable.” Perhaps it is time for them to consider a course correction to improve the viability of their actionable science proposals. A few basic steps may help rejigger the science planning process in this direction and, consequently, help avoid the researcher's lament. The likelihood of gaining support during the proposal review and award adjudication process, and securing practical application of scientific products, increases when the products are (1) the result of active engagement of researchers with decision makers; (2) better connected to social and political priorities; (3) clearly designed to inform specific management decisions; and (4) tailored to fit the needs of targeted end users. These considerations and activities exist beyond the comfort zone of many environmental or conservation scientists. Yet, those who adopt them will spend less time lamenting rejection and become more influential in the production of actionable knowledge.

The Importance of Informational Components of Sparkling Wine Labels Varies with Key Consumer Characteristics

Wine label information is an important aid for consumers in making purchase decisions. However, the influence of label information types in the context of sparkling wines is poorly understood, despite the global growth of this product class. Using an online survey of 576 Ontario sparkling wine consumers, we sought to examine this knowledge gap using two complementary approaches. First, participants were presented with a set of two mock sparkling wine labels, selected at random, from a set of eight conditions. One condition (control) contained all seven of the information types previously identified (endorsements, parentage, attributes, target end use, target end user, manufacture, nonpareil), whereas the other seven omitted one of each of these elements. Respondents then rated their willingness to buy, willingness to pay, and the perception of quality. Lastly, they self-rated the importance placed on 14 different label information statements when purchasing sparkling wine (5-point Likert scale from 1–not at all important to 5–extremely important). Results show that including a description of the wine’s sensory attributes on sparkling wine labels is important to consumers overall, except for those with a high subjective knowledge of sparkling wine, and those who normally spend more than CAD 30 per bottle, as these groups are more willing to buy, willing to pay, and rate their perception of quality higher for labels that do not include attribute information. Grape variety/blend and production region information are rated high in importance. Alcohol content is more important to young consumers and those who prefer Prosecco-style sparkling wines, whereas vintage/year is more important to consumers who prefer Champagne-style sparkling wines. Expert endorsements are rated low in importance, and younger consumers are more willing to buy sparkling wine with the endorsement information removed. We conclude that sparkling wine label information content should be optimised for different market segments and consumer characteristics. This study provides important insights that can guide sparkling wine marketers and retailers in this process.

A Web-Based Health Application to Translate Nutrition Therapy for Cardiovascular Risk Reduction in Primary Care (PortfolioDiet.app): Quality Improvement and Usability Testing Study.

BackgroundThe Portfolio Diet, or Dietary Portfolio, is a therapeutic dietary pattern that combines cholesterol-lowering foods to manage dyslipidemia for the prevention of cardiovascular disease. To translate the Portfolio Diet for primary care, we developed the PortfolioDiet.app as a patient and physician educational and engagement tool for PCs and smartphones. The PortfolioDiet.app is currently being used as an add-on therapy to the standard of care (usual care) for the prevention of cardiovascular disease in primary care. To enhance the adoption of this tool, it is important to ensure that the PortfolioDiet.app meets the needs of its target end users.ObjectiveThe main objective of this project is to undertake user testing to inform modifications to the PortfolioDiet.app as part of ongoing engagement in quality improvement (QI).MethodsWe undertook a 2-phase QI project from February 2021 to September 2021. We recruited users by convenience sampling. Users included patients, family physicians, and dietitians, as well as nutrition and medical students. For both phases, users were asked to use the PortfolioDiet.app daily for 7 days. In phase 1, a mixed-form questionnaire was administered to evaluate the users’ perceived acceptability, knowledge acquisition, and engagement with the PortfolioDiet.app. The questionnaire collected both quantitative and qualitative data, including 2 open-ended questions. The responses were used to inform modifications to the PortfolioDiet.app. In phase 2, the System Usability Scale was used to assess the usability of the updated PortfolioDiet.app, with a score higher than 70 being considered acceptable.ResultsA total of 30 and 19 users were recruited for phase 1 and phase 2, respectively. In phase 1, the PortfolioDiet.app increased users’ perceived knowledge of the Portfolio Diet and influenced their perceived food choices. Limitations identified by users included challenges navigating to resources and profile settings, limited information on plant sterols, inaccuracies in points, timed-logout frustration, request for step-by-step pop-up windows, and request for a mobile app version; when looking at positive feedback, the recipe section was the most commonly praised feature. Between the project phases, 6 modifications were made to the PortfolioDiet.app to incorporate and address user feedback. At phase 2, the average System Usability Scale score was 85.39 (SD 11.47), with 100 being the best possible.ConclusionsBy undertaking user testing of the PortfolioDiet.app, its limitations and strengths were able to be identified, informing modifications to the application, which resulted in a clinical tool that better meets users’ needs. The PortfolioDiet.app educates users on the Portfolio Diet and is considered acceptable by users. Although further refinements to the PortfolioDiet.app will continue to be made before its evaluation in a clinical trial, the result of this QI project is an improved clinical tool.

Personas for Better Targeted eHealth Technologies: User-Centered Design Approach.

BackgroundThe full potential of eHealth technologies to support self-management and disease management for patients with chronic diseases is not being reached. A possible explanation for these lacking results is that during the development process, insufficient attention is paid to the needs, wishes, and context of the prospective end users. To overcome such issues, the user-centered design practice of creating personas is widely accepted to ensure the fit between a technology and the target group or end users throughout all phases of development.ObjectiveIn this study, we integrate several approaches to persona development into the Persona Approach Twente to attain a more holistic and structured approach that aligns with the iterative process of eHealth development.MethodsIn 3 steps, a secondary analysis was carried out on different parts of the data set using the Partitioning Around Medoids clustering method. First, we used health-related electronic patient record data only. Second, we added person-related data that were gathered through interviews and questionnaires. Third, we added log data.ResultsIn the first step, 2 clusters were found, with average silhouette widths of 0.12 and 0.27. In the second step, again 2 clusters were found, with average silhouette widths of 0.08 and 0.12. In the third step, 3 clusters were identified, with average silhouette widths of 0.09, 0.12, and 0.04.ConclusionsThe Persona Approach Twente is applicable for mixed types of data and allows alignment of this user-centered design method to the iterative approach of eHealth development. A variety of characteristics can be used that stretches beyond (standardized) medical and demographic measurements. Challenges lie in data quality and fitness for (quantitative) clustering.

Informing the Future of Integrated Digital and Clinical Mental Health Care: Synthesis of the Outcomes From Project Synergy.

BackgroundGlobally, there are fundamental shortcomings in mental health care systems, including restricted access, siloed services, interventions that are poorly matched to service users’ needs, underuse of personal outcome monitoring to track progress, exclusion of family and carers, and suboptimal experiences of care. Health information technologies (HITs) hold great potential to improve these aspects that underpin the enhanced quality of mental health care.ObjectiveProject Synergy aimed to co-design, implement, and evaluate novel HITs, as exemplified by the InnoWell Platform, to work with standard health care organizations. The goals were to deliver improved outcomes for specific populations under focus and support organizations to enact significant system-level reforms.MethodsParticipating health care organizations included the following: Open Arms–Veterans & Families Counselling (in Sydney and Lismore, New South Wales [NSW]); NSW North Coast headspace centers for youth (Port Macquarie, Coffs Harbour, Grafton, Lismore, and Tweed Heads); the Butterfly Foundation’s National Helpline for eating disorders; Kildare Road Medical Centre for enhanced primary care; and Connect to Wellbeing North Coast NSW (administered by Neami National), for population-based intake and assessment. Service users, families and carers, health professionals, and administrators of services across Australia were actively engaged in the configuration of the InnoWell Platform to meet service needs, identify barriers to and facilitators of quality mental health care, and highlight potentially the best points in the service pathway to integrate the InnoWell Platform. The locally configured InnoWell Platform was then implemented within the respective services. A mixed methods approach, including surveys, semistructured interviews, and workshops, was used to evaluate the impact of the InnoWell Platform. A participatory systems modeling approach involving co-design with local stakeholders was also undertaken to simulate the likely impact of the platform in combination with other services being considered for implementation within the North Coast Primary Health Network to explore resulting impacts on mental health outcomes, including suicide prevention.ResultsDespite overwhelming support for integrating digital health solutions into mental health service settings and promising impacts of the platform simulated under idealized implementation conditions, our results emphasized that successful implementation is dependent on health professional and service readiness for change, leadership at the local service level, the appropriateness and responsiveness of the technology for the target end users, and, critically, funding models being available to support implementation. The key places of interoperability of digital solutions and a willingness to use technology to coordinate health care system use were also highlighted.ConclusionsAlthough the COVID-19 pandemic has resulted in the widespread acceptance of very basic digital health solutions, Project Synergy highlights the critical need to support equity of access to HITs, provide funding for digital infrastructure and digital mental health care, and actively promote the use of technology-enabled, coordinated systems of care.

An Agile Development Cycle of an Online Memory Program for Healthy Older Adults.

Online interventions for older adults should be tailored to their unique needs to increase the efficacy of and adherence to the intervention. The agile development cycle is a dynamic model to solicit and incorporate feedback from older adults during the design process. We combined this approach with the framework of Harvard University's clinical and translational phases that provide a clear structure for evaluating new health programs before they are offered in the community. We based our online memory program on the empirically validated in-person Memory and Aging Program. The aim of the present study was to combine the agile development cycle with the clinical and translational phases framework to develop and pilot an online memory program tailored to the unique needs of older adults. Study 1 involved piloting individual program modules on site and integrating participant feedback into the program's design to optimize usability. Study 2 involved two sequential pilots of the program accessed remotely to evaluate preliminary clinical outcomes and obtain feedback for iterative modifications. Plans for further validation and limitations are discussed. The successful application of the agile development cycle implemented in this series of studies can be adapted by others seeking to offer online content for targeted end users.