User-centered Design Principles Research Articles

Challenges and Opportunities of Gamified BCI and BMI on Disabled People Learning: A Systematic Review

This systematic review explores the potential of the gamified brain–machine interfaces (BMIs) and brain–computer interfaces (BCIs) to enhance the quality of life for individuals with disabilities. These technologies promise to solve complex problems by delivering customized interventions considering individual needs, ethical dilemmas, and practical constraints. This review follows the PRISMA statement. The search process extensively explored multiple registered databases for studies published between 2015 and 2024. Articles were selected based on strict eligibility criteria, focusing on empirical research evaluating gamified BCIs and BMIs in rehabilitation and learning. The final analysis included 56 studies. A thorough examination emphasizes the transformative potential of gamified BCIs and BMIs for people with disabilities, highlighting the need for interdisciplinary collaboration, user-centered design principles, and ethical consciousness for gamified neurotechnology. These technologies mark a significant change by providing enjoyable and effective treatments for disabled individuals. It also delves into how gamification, neurofeedback, and adaptive learning techniques can enhance motivation, engagement, and overall well-being. This evaluation underscores the efficiency of gamified BCIs and BMIs as potential instruments for improving the quality of life and empowering disabled people. However, despite their apparent potential for rehabilitation and learning, more research is needed to validate their effectiveness, accessibility, and long-term benefits.

Validating the RISE Communication Play Protocol as a Diagnostic Tool for Autism in Early Childhood: A Pilot Study.

There are few validated remote tools that can be used to assess for autism and to capture subtle changes in children's social communication over time. Recently, user-centered design principles were applied to develop a parent-mediated remote assessment, the Reciprocal Imitation and Social Engagement Child Play Protocol (RISE CPP) to enable researchers to capture micro-level behaviors in children, while promoting useability for researchers and families, reducing caregiver burden, and maintaining reliability. This paper describes a pilot study to validate the RISE CPP as a tool to support clinician diagnosis of autism. Thirty-eight caregiver-child dyads (24-41months, M = 34, SD = 4; 86% male) completed a remote parent-mediated assessment at home (RISE CPP) and an in-lab clinician-led assessment (Autism Diagnostic Observation Schedule; ADOS-2). Independent clinician diagnosis based on observations across the remote and in-lab assessments showed agreement for all but one child (K = .89). Clinicians completing in-person and remote assessments reported similar levels of confidence in their diagnoses, t(37) = 0.93, p = .36, d = .15. Mixed-methods analysis revealed unique benefits and challenges to the remote and in-person assessments and suggested that both assessments were acceptable to caregivers. Results provide preliminary support for the RISE CPP as a diagnostic tool. The remote administration may increase equity for clinical and research diagnostic assessments among families who are traditionally underserved and underrepresented in research.

Current state and promise of user-centered design to harness explainable AI in clinical decision-support systems for patients with CNS tumors.

In neuro-oncology, MR imaging is crucial for obtaining detailed brain images to identify neoplasms, plan treatment, guide surgical intervention, and monitor the tumor's response. Recent AI advances in neuroimaging have promising applications in neuro-oncology, including guiding clinical decisions and improving patient management. However, the lack of clarity on how AI arrives at predictions has hindered its clinical translation. Explainable AI (XAI) methods aim to improve trustworthiness and informativeness, but their success depends on considering end-users' (clinicians') specific context and preferences. User-Centered Design (UCD) prioritizes user needs in an iterative design process, involving users throughout, providing an opportunity to design XAI systems tailored to clinical neuro-oncology. This review focuses on the intersection of MR imaging interpretation for neuro-oncology patient management, explainable AI for clinical decision support, and user-centered design. We provide a resource that organizes the necessary concepts, including design and evaluation, clinical translation, user experience and efficiency enhancement, and AI for improved clinical outcomes in neuro-oncology patient management. We discuss the importance of multi-disciplinary skills and user-centered design in creating successful neuro-oncology AI systems. We also discuss how explainable AI tools, embedded in a human-centered decision-making process and different from fully automated solutions, can potentially enhance clinician performance. Following UCD principles to build trust, minimize errors and bias, and create adaptable software has the promise of meeting the needs and expectations of healthcare professionals.

Redesign of User Experience in Inaportnet Using the User Experience Questionnaire Method TND User-Centered Design

The Directorate General of Sea Transportation, under Indonesia's Ministry of Transportation, developed Inaportnet as a digital platform mandated by Ministerial Regulation Number PM 8 of 2022 to streamline ship service procedures and enhance e-government implementation. This study evaluates the user experience (UX) of the Inaportnet website, focusing on its usability, security, and overall design using a user-centred design (UCD) approach and the User Experience Questionnaire (UEQ) method. Data were collected from 56 respondents, including stakeholders such as ship operators, port authorities, and service users. The findings reveal critical shortcomings: 95% of respondents encountered frequent bugs affecting usability, 65% highlighted security concerns, 60% criticised the cluttered interface, 40% experienced access failures, and 50% expressed low engagement with the platform's features. To address these challenges, the website was redesigned using UCD principles, resulting in significant improvements. The redesigned platform achieved "Good" ratings for attractiveness, stimulation, and novelty, and "Above Average" ratings for clarity, efficiency, and accuracy in UEQ metrics, indicating enhanced usability and user satisfaction. This study underscores the importance of iterative UX design in optimising digital government systems, offering actionable insights for improving public service platforms in developing countries.

Exploring the use and usefulness of living guidelines for consumers: international online survey of patients' and carers' views.

Living guidelines contain continually updated, and potentially changing, clinical recommendations. The implications of living guidelines for consumers (e.g. patients, carers, people with lived experience) - particularly how living guidelines should be developed and disseminated - are yet to be established. To explore consumers' views about how best to support the use and usefulness of living guidelines to consumers. Qualitative (online survey) SETTING AND PARTICIPANTS: We invited consumers who were familiar with guidelines (living or conventional) to participate in the study. The survey was distributed globally. Recruitment was conducted via the Australian and international networks of the Australian Living Evidence Collaboration. The 5-10-minute survey collected demographic data then, after introducing the living guidelines concept, asked questions about what living guidelines mean for consumers, how we might make them easy for consumers to find and use, and potential challenges to their use. We analysed the data using inductive thematic analysis. Forty-five people (71% women) from 12 countries completed the survey. Participants were enthusiastic about the concept of living guidelines and what they might mean for consumers' ability to make informed healthcare decisions and receive best care. They also identified potential challenges related to living guideline dissemination, such as low public awareness of guidelines and confusion about updated recommendations. Participants described practical strategies to support consumers' awareness and use of, and access to, living guidelines. These included: meaningful involvement of consumers in the development and dissemination of living guidelines; raising awareness by promoting the guidelines widely through trusted health information sources and on social media; and using user-centred formatting and design principles (e.g. considering accessibility needs, and publishing lay summaries with plain and culturally-appropriate language). Consumers suggested a comprehensive range of dissemination strategies to support the use and usefulness of living guidelines to consumers, which largely reflect best practice in conventional guideline dissemination. Promoting and explaining the living nature of guideline recommendations might support their use by consumers. There should also be a close link between the living guidelines and any versions or additional content created for both consumers and clinicians.

Usability of a Cloud-Based Home Healthcare Client Monitoring Platform: A Simulation-Based Approach.

The aim of this study was to assess the usability of a cloud-based home healthcare monitoring platform (CHHM). A proof of concept using a simulated client scenario was used in this study. Using a mixed-methods approach, a convenience sample of 14 nursing students was used to assess the usability of CHHM during a simulation. Students engaged in evaluation using two questionnaires: the Post-Study System Usability Questionnaire (Usability Questionnaire) and a researcher-developed questionnaire incorporating qualitative responses. The overall mean score of the Usability Questionnaire was 2.91, with the range of 7, indicating the usability of the platform. The Usability Questionnaire was negatively scored, with 1 being the best. The means of the two subscales, System Usefulness (2.77) and Information Quality (3.26), illustrated the platform's solid performance. The Interface Quality subscale mean was 2.94, indicating a lower level of satisfaction. Qualitative data from the researcher-developed questionnaire indicated that participants found the platform straightforward, clear, and user-friendly, with the potential to enhance practice. This platform may enhance rehabilitation nurses' ability to monitor clients at home. The CHHM can support and enhance the delivery of home health care by enabling continuous remote monitoring. By incorporating user-centered design principles, cloud-native architecture, and wearable sensors, we demonstrated a proof of concept and laid the foundation for further platform development.

User-Centred Design and Development of a Smartphone Application (OverSight) for Digital Phenotyping in Ophthalmology.

Visual impairment can significantly impact an individual's daily activities. Patients require regular monitoring, typically occurring within hospital eye services. Capacity constraints have necessitated innovative solutions to improve patient care. Existing digital solutions rely on task-based digital home monitoring such as visual acuity testing. These require active involvement from patients and do not typically offer an indication of quality of life. Digital phenotyping refers to the use of personal digital devices to quantify passive behaviour for detecting clinically significant changes in vision and act as biomarkers for disease. Its uniqueness lies in the ability to detect changes passively. The objective was to co-design an accessible smartphone app (OverSight) for the purposes of digital phenotyping in people with sight impairment. Development of OverSight included stakeholder consultations following principles of user-centred design. Apple iOS software frameworks (HealthKit, ResearchKit, and SensorKit) and a SwiftUI developer toolkit were used to enable the collection of active and passive data streams. Accessibility and usability were assessed using the System Usability Scale (SUS) and feedback following a 3-month pilot study. Consultations with patients informed the design of OverSight, including preferred survey scheduling and the relevancy of patient support resources. Twenty visually impaired participants (mean age 42 ± 19 years) were recruited to the pilot study. The average score on the SUS was 76.8 (±8.9), indicating good usability. There was a statistically significant moderate negative correlation between SUS scores and visual acuity in both the better (r = -0.494; p ≤ 0.001) and worse eye (r = -0.421; p ≤ 0.001). OverSight offers promising potential for collecting patient-generated health data for the purposes of digital phenotyping in patients with eye disease. Through further testing and validation, this novel approach to patient care may ultimately provide opportunities for remote monitoring in ophthalmology.

User-Centered Design and Usability Testing of an Air Handling Unit testing application

In recent years, the design of user interfaces and user experience has become more relevant in companies due to the need to optimize the interaction between users and complex interactive systems. This study aims to establish design guidelines to improve the user experience in engineering applications in teams of Air handling unit testing engineers. A redesign process of a handling unit testing application was conducted using a user-centered design approach through in-depth interviews, user profiling, interactive prototyping, and usability testing. The results obtained showed a significant improvement in usability and user experience by implementing the fundamentals and principles of user-centered design. This case study highlighted the fundamental role of user interface and user experience design so that user interface designers and engineers can reference the learnings and findings to improve their applications to optimize the tasks of handling unit testing engineers.

Integrating learner-centered design and user-centered design for meaningful instructor onboarding: Supporting large-scale curricular changes to general education

Supporting instructors through large-scale curricular changes to cross-disciplinary programs such as general education is a complex challenge. In this case-based narrative, we describe how one large R1 university in the Southwest United States developed and implemented an instructor support program during a large-scale general education program redesign for a program that had not been substantively revised since 1998. This program typically offers about 500 courses each semester and is taught by roughly 650 instructors. To support the phased rollout of the new program curriculum, we designed and implemented a Quick Start program to support instructors revising courses for the new program, serving over 400 instructors during its first year of implementation. We discuss our integration of learner-centered design principles (McCombs & Whisler, 1997; Weimer, 2013) to guide the development of the Quick Start program and user-centered design principles (Greer & Harris, 2018; Tham, 2022) to create accessible, useful, and context-driven learning content for the instructors. While these frameworks have been integrated in the past to develop learning materials for students (Jones, 2018; Shivers-McNair et al., 2018), our case-based descriptive analysis presents a novel application of this integration for faculty development. We describe how we integrated these principles to design, scale, iterate, and implement instructor onboarding to the new curriculum. Specifically, we offer four guiding pillars: (i) creating an aligned learning experience, (ii) building an instructional community, (iii) foregrounding an asset-based approach, and (iv) creating useful and usable materials to operationalize such an integration of learner-centered and user-centered design approaches for faculty development.

Navigation Training for Persons With Visual Disability Through Multisensory Assistive Technology: Mixed Methods Experimental Study.

Visual disability is a growing problem for many middle-aged and older adults. Conventional mobility aids, such as white canes and guide dogs, have notable limitations that have led to increasing interest in electronic travel aids (ETAs). Despite remarkable progress, current ETAs lack empirical evidence and realistic testing environments and often focus on the substitution or augmentation of a single sense. This study aims to (1) establish a novel virtual reality (VR) environment to test the efficacy of ETAs in complex urban environments for a simulated visual impairment (VI) and (2) evaluate the impact of haptic and audio feedback, individually and combined, on navigation performance, movement behavior, and perception. Through this study, we aim to address gaps to advance the pragmatic development of assistive technologies (ATs) for persons with VI. The VR platform was designed to resemble a subway station environment with the most common challenges faced by persons with VI during navigation. This environment was used to test our multisensory, AT-integrated VR platform among 72 healthy participants performing an obstacle avoidance task while experiencing symptoms of VI. Each participant performed the task 4 times: once with haptic feedback, once with audio feedback, once with both feedback types, and once without any feedback. Data analysis encompassed metrics such as completion time, head and body orientation, and trajectory length and smoothness. To evaluate the effectiveness and interaction of the 2 feedback modalities, we conducted a 2-way repeated measures ANOVA on continuous metrics and a Scheirer-Ray-Hare test on discrete ones. We also conducted a descriptive statistical analysis of participants' answers to a questionnaire, assessing their experience and preference for feedback modalities. Results from our study showed that haptic feedback significantly reduced collisions (P=.05) and the variability of the pitch angle of the head (P=.02). Audio feedback improved trajectory smoothness (P=.006) and mitigated the increase in the trajectory length from haptic feedback alone (P=.04). Participants reported a high level of engagement during the experiment (52/72, 72%) and found it interesting (42/72, 58%). However, when it came to feedback preferences, less than half of the participants (29/72, 40%) favored combined feedback modalities. This indicates that a majority preferred dedicated single modalities over combined ones. AT is crucial for individuals with VI; however, it often lacks user-centered design principles. Research should prioritize consumer-oriented methodologies, testing devices in a staged manner with progression toward more realistic, ecologically valid settings to ensure safety. Our multisensory, AT-integrated VR system takes a holistic approach, offering a first step toward enhancing users' spatial awareness, promoting safer mobility, and holds potential for applications in medical treatment, training, and rehabilitation. Technological advancements can further refine such devices, significantly improving independence and quality of life for those with VI.

Harmonizing human-computer interaction: Exploring evolution and integration in media and computing

Abstract. This paper delves into the intricate relationship between Human-Computer Interaction (HCI), media, and computing, examining its historical evolution and contemporary challenges. From the rudimentary interfaces of the 1970s to the immersive digital experiences of the present day, HCI has undergone a profound transformation, driven by advancements in technology and changing user expectations. The convergence of media and computing technologies has blurred traditional boundaries, reshaping user interactions and opening new frontiers for research and innovation. Through quantitative analysis and mathematical modeling, researchers gain insights into user behavior, preferences, and interactions, informing the design of more intuitive and engaging interactive systems. However, this integration also poses challenges related to cross-platform compatibility, ethical considerations, and accessibility. By embracing user-centered design principles, ethical stewardship, and technological innovation, HCI researchers and practitioners can navigate these challenges and shape the future of HCI-Media-Computing integration.

Optimising Wood Waste Utilization: A Study on Upcycling Techniques to Create High-Value Products in Boyolali's Creative Industry

The UMKM involved in this community partnership program is engaged in the production of teak wood furniture. The issues currently faced are (1) a limited range of furniture products and (2) traditional management and marketing methods. This study aimed to implement technological induction to enhance productivity, creativity, and competitiveness within these UMKMs. The technological induction involved providing modern production tools for creating innovative products and developing an application boot program and server computer to enhance marketing efforts. A mixed-methods approach was used, combining case study observations and user-centred design principles to create technological solutions. The program's outcomes were assessed through partner training and mentoring, employing a problem-solving approach to address post-implementation challenges. The study found that introducing advanced production tools and digital marketing strategies significantly increased the variety of products, streamlined production processes, and expanded market reach, positioning the UMKMs for improved competitiveness in the national market. This research underscores the importance of integrating technology into small-scale industries for sustainable growth. Future efforts should focus on scaling these practices to other creative sectors for broader economic impact.

Understanding user experience and normative data in pharyngeal residue rating scales used in flexible endoscopic evaluation of swallowing (FEES): A scoping review

Purpose Pharyngeal residue rating scales are often used to rate pharyngeal residue observed during flexible endoscopic evaluation of swallowing. Despite the widespread use of pharyngeal residue rating scales, there is no data that has systematically explored user experience. The aim of this scoping review was to investigate specific reporting of user experience, user centred design principles, and normative data in the development of pharyngeal residue rating scales. Method A scoping review was conducted across four electronic databases inclusive of all dates until June 2024. Grey literature searching occurred in March–April 2023 and was repeated in June 2024. This review followed the Preferred Reporting Items for Systematic Review and Meta-Analyses extension for Scoping Reviews (PRISMA-ScR) protocol. Titles/abstracts, full texts, and data extraction were reviewed by two independent reviewers. Result A total of 22 sources were included, with 18 unique pharyngeal residue rating scales identified. Two studies referred to user experience, seven included at least one user centred design principle, and four studies reported on normative data. Conclusion The findings of this review highlight few pharyngeal residue rating scales include the experience of the intended user and establish normative data in the initial development phase. User experience, user centred design principles, and normative data may be useful considerations to optimise functionality.

Clinical Decision Support to Increase Emergency Department Naloxone Coprescribing: Implementation Report.

Coprescribing naloxone with opioid analgesics is a Centers for Disease Control and Prevention (CDC) best practice to mitigate the risk of fatal opioid overdose, yet coprescription by emergency medicine clinicians is rare, occurring less than 5% of the time it is indicated. Clinical decision support (CDS) has been associated with increased naloxone prescribing; however, key CDS design characteristics and pragmatic outcome measures necessary to understand replicability and effectiveness have not been reported. This study aimed to rigorously evaluate and quantify the impact of CDS designed to improve emergency department (ED) naloxone coprescribing. We hypothesized CDS would increase naloxone coprescribing and the number of naloxone prescriptions filled by patients discharged from EDs in a large health care system. Following user-centered design principles, we designed and implemented a fully automated, interruptive, electronic health record-based CDS to nudge clinicians to coprescribe naloxone with high-risk opioid prescriptions. "High-risk" opioid prescriptions were defined as any opioid analgesic prescription ≥90 total morphine milligram equivalents per day or for patients with a prior diagnosis of opioid use disorder or opioid overdose. The Reach, Effectiveness, Adoption, Implementation, and Maintenance (RE-AIM) framework was used to evaluate pragmatic CDS outcomes of reach, effectiveness, adoption, implementation, and maintenance. Effectiveness was the primary outcome of interest and was assessed by (1) constructing a Bayesian structural time-series model of the number of ED visits with naloxone coprescriptions before and after CDS implementation and (2) calculating the percentage of naloxone prescriptions associated with CDS that were filled at an outpatient pharmacy. Mann-Kendall tests were used to evaluate longitudinal trends in CDS adoption. All outcomes were analyzed in R (version 4.2.2; R Core Team). Between November 2019 and July 2023, there were 1,994,994 ED visits. CDS reached clinicians in 0.83% (16,566/1,994,994) of all visits and 15.99% (16,566/103,606) of ED visits where an opioid was prescribed at discharge. Clinicians adopted CDS, coprescribing naloxone in 34.36% (6613/19,246) of alerts. CDS was effective, increasing naloxone coprescribing from baseline by 18.1 (95% CI 17.9-18.3) coprescriptions per week or 2,327% (95% CI 3390-3490). Patients filled 43.80% (1989/4541) of naloxone coprescriptions. The CDS was implemented simultaneously at every ED and no adaptations were made to CDS postimplementation. CDS was maintained beyond the study period and maintained its effect, with adoption increasing over time (τ=0.454; P<.001). Our findings advance the evidence that electronic health record-based CDS increases the number of naloxone coprescriptions and improves the distribution of naloxone. Our time series analysis controls for secular trends and strongly suggests that minimally interruptive CDS significantly improves process outcomes.

Designing for Safety: A Review of Human-Centered Approaches in Evacuation App Development

This review focuses on the development of evacuation apps used in emergencies with the principal role of User-Centered Design (UCD). With intensifying dependence on technological growth, precisely emergency evacuation scenarios, these apps are helpful for their usage and design. This study sheds light on the importance of user experience by designing human-centric elements and integrating them into user experience. It is ensured explicitly that their accessibility and effectiveness during high-stress situations do not impact the app's functionality. Existing apps lack interface useability regarding human-centric approaches, present inconsistent information, and lack disability and demographic integration, causing a bad user experience. Incorporation of UCD principles of usability, user needs, and iterative design, the design of more inclusive and responsive apps meets these critical challenges identified in the review. The recommendations, thus provided, help improve functionality as well as usability. The objective of this paper is to support the development of user-friendly apps facilitating users during emergencies following an in-depth literature review of such apps being used in such scenarios.

Extubation Advisor: Implementation and Evaluation of A Novel Extubation Clinical Decision Support Tool.

Extubation Advisor (EA) is a novel software tool that generates a synoptic report for each Spontaneous Breathing Trial (SBT) conducted to inform extubation decision-making. To assess bedside EA implementation, perceptions of utility, and identify barriers and facilitators of use. We conducted a phase I mixed-methods interventional study in three mixed intensive care unit (ICUs) in two academic hospitals. We interviewed critical care physicians (MDs) and respiratory therapists (RTs) regarding user-centered design principles and usability. We evaluated our ability to consent participants (feasibility threshold 50%), capture complete data (threshold 90%), generate and review EA reports in real-time (thresholds 75% and 80%, respectively), and MD perception of tool usefulness (6-point Likert scale). We analyzed interview transcripts using inductive coding to identify facilitators and barriers to EA implementation and perceived benefit of tool use. We enrolled 31 patients who underwent 70 SBTs. Although consent rates [31/31 (100%], complete data capture [68/68 (100%)], and EA report generation [68/70 (97.1%)] exceeded feasibility thresholds, reports were reviewed by MDs for [55/70 (78.6%)] SBTs. Mean MD usefulness score was 4.0/6. Based on feedback obtained from 36 interviews (15 MDs, 21 RTs), we revised the EA report twice and identified facilitators (ability to track patient progress, enhance extubation decision-making, and provide support in resource-limited settings) and barriers (resource constraints, need for education) to tool implementation. Half of respondents (9 MDs, 9 RTs; combined 50%) perceived definite or potential benefit to EA tool use. This is the first study of a waveform-based variability-derived, predictive clinical decision support tool evaluated in adult ICUs. Our findings support the feasibility of integrating the EA tool into bedside workflow. Clinical trials are needed to assess the utility of the EA tool in practice and its impact on extubation decision-making and outcomes. NCT04708509.

Revitalizing Interest in Traditional Malaysian Games Among the Younger Generation Through Mobile Applications: An Interface Design Approach

The rich heritage of traditional Malaysian games is at risk of fading in the face of modern digital entertainment, particularly among younger generations. This study explores how mobile applications can serve as a platform to revitalize interest in these games by employing an innovative interface design approach. Focusing on user-centred design principles, this paper highlights the importance of visual appeal, ease of use, and engagement in encouraging younger users to interact with this cultural artefact. By combining tradition with technology, the research demonstrates how thoughtfully designed mobile applications can preserve cultural heritage while resonating with the digital-native generation. The findings present a framework for integrating cultural education into modern gaming experiences, contributing to preserving Malaysia's unique cultural identity.

A Roadmap for the Design of a Public-participation Geographic-Information System to Support Urban Ageing

Geospatial technologies have the potential to transform the lives of older adults by providing them with necessary tools to navigate their local communities, access services, connect with others, and access valuable information. However, the usability and accessibility of such technologies often fall short of the needs of older adults. Many existing geospatial tools are not designed with the needs and preferences of older adults in mind; this can lead to usability challenges and limit their usage. This paper explores a participatory approach in developing an inclusive geodata-collection tool that is specifically tailored to older users’ needs. The paper also highlights the importance of incorporating user-centered design principles, participatory design methods, and accessibility guidelines throughout the entire geodata-tool-development process. It also emphasizes the need for ongoing user engagement and feedback in order to ensure that the tool remains relevant and usable in the evolving digital landscape. This participatory approach has resulted in a tool that is easy to use and accessible for older adults; it is available in various languages, thus ensuring that the elderly can actively participate in the prototype’s creation and contribute to the collection of the geospatial information that reflects their lived experiences and needs.

A Culturally Sensitive Mobile App (DiaFriend) to Improve Self-Care in Patients With Type 2 Diabetes: Development Study.

Mobile apps designed with cultural sensitivity have demonstrated higher user acceptability and greater effectiveness in enhancing self-care skills. However, a significant gap exists in developing such apps for specific populations, such as Portuguese Americans living in southern Massachusetts, home to the second-largest Portuguese community in the United States. This group possesses unique cultural traditions, particularly in dietary practices, including a tendency toward high carbohydrate intake. Tailoring diabetes self-care apps to address these specific cultural requirements could substantially improve diabetes management within this population. The aim of this app development project was to develop a prototype diabetes management app for Portuguese Americans with type 2 diabetes mellitus using the design thinking methodology, incorporating user-centered design principles and cultural sensitivity. This paper describes the phase-2 results, focusing on app design and development. Phase 2 of this app development project adhered to the design thinking methodology delineated by the Hasso Plattner Institute of Design at Stanford University, focusing on 2 critical steps: ideation and prototyping. This phase started in March 2022 and continued until April 2024. The project was driven by a multidisciplinary team consisting of 2 nurse educators; an app development specialist; and 2 graduate research assistants from the university's Computer and Information Sciences Department, both well-versed in mobile app development. Data collected during phase 1, which will be published separately, informed the app design and development process. The prototype of the DiaFriend app (version 1) was designed and developed. The app comprises five features: (1) blood glucose monitoring, (2) weight tracking, (3) carbohydrate tracking, (4) exercise log, and (5) medication reminder. The carbohydrate tracking feature was explicitly tailored to correspond to Portuguese food culture. This paper presents the front-end interface flowchart, demonstrating how the user navigates through each screen. It also discusses the challenges faced during the backend development, such as data not being able to be stored and retrieved. The DiaFriend app (version 1) distinguishes itself from conventional diabetes self-care apps through its emphasis on cultural sensitivity. The development of this app underscores the importance of cultural considerations in health informatics. It establishes a foundation for future research in developing and evaluating culturally sensitive mobile health apps. The adaptation of such technologies has the potential to enhance self-care practices among Portuguese Americans with type 2 diabetes mellitus, with improved glycated hemoglobin levels as a potential outcome. The last step of the design thinking methodology, testing the app, will be conducted in phase 3 and the results will be published elsewhere.

Usability Evaluation of the Revised Color Me Healthy Symptom Assessment App: Perspectives of Children and Parents.

The Color Me Healthy symptom reporting app was co-designed with school-age children with cancer, their parents, and clinicians. Preliminary studies demonstrated its feasibility and acceptability; however, children and parents identified the need for additional refinements. Guided by the Technology Acceptance Model and principles of user-centered design, this study supported refinements to the Color Me Healthy user interface and evaluation of its usability. As the programming team completed builds of the app, school-age children with cancer and their parents participated in cognitive walkthrough usability evaluations and qualitative interviews. Usability logs documented the completion of key tasks related to reporting pain and review of child-reported data. Parents completed the Technology Acceptance Model Perceived Usefulness Scale (TAM-PUS). Interview responses were analyzed using qualitative content analysis. Fourteen children (median age 8.5 years; range 6-12) and 14 parents (median age 38.5 years; range 34-49) participated in one of three usability evaluation cycles. After the third cycle, children and parents navigated the app and completed key tasks independently. Median TAM-PUS scores were 6 (range 6-8), indicating high perceived usefulness. Qualitative analyses indicated that children regarded the app as easy and fun to use. Parents emphasized the app's developmental relevance for their child and for themselves as the child's caregiver. This study demonstrates the perceived usefulness and perceived ease of use of the revised Color Me Healthy app. Optimizing the usability of the Color Me Healthy app with attention to the user needs of children and parents positions the app for wider-scale clinical implementation.