Insulin pumps are designed for the self-management of diabetes mellitus in patients and are known for their complexity of use. Pump manufacturers engage trainers to teach patients how to use the devices correctly to control the symptoms of their disease. Usability research related to insulin pumps and other infusion pumps with first-time users as participants has centered on the relationship between user interface design and the effectiveness of task completion. According to prior research, the characteristics of system behavior in a real life environment remain elusive. A suitable approach to acquire information about potential usability problems encountered by first-time users is to obtain this information from the health care professionals who train them. The purpose of the study was to discover the lived experiences and shared impressions of insulin pump trainers during training sessions with first-time users. Interpretative Phenomenological Analysis (IPA) was used to uncover the phenomena associated with usability challenges that first-time users of insulin pumps face when learning to use the device. Six participants representing a homogeneous sample were recruited from a wide geographic area in the United States, and semi-structured interviews containing open-ended questions were conducted with the respondents. The data from the lived experiences and shared impressions of the participants were used to develop the following five super-ordinate themes: Emotion-charged Environment, Personalized Training, Safety Issues and Disaster Planning, Professional Dedication, and The Voice. The essence of participants’ experience was described around the pivotal moment when the training sessions are successfully completed and insulin pump therapy becomes alive. The findings of this study have implications for information systems professionals who conduct research on the safe design and usability of safety critical medical devices. In addition, the findings from this study create opportunities for practice to improve the initiation of insulin pump therapy in patients with diabetes.

Indiana University-Purdue University Indianapolis (IUPUI) / Primary users can create a user experience (UX) for others—secondary users— when interacting with a system in public. Common ground occurs when people have certain knowledge in common and each knows that they have this shared understanding. This research investigates how designing for a secondary UX improves common ground during a patient-provider first encounter. During formative work, patients and providers participated in telephonic interviews and answered online questionnaires so that their respective information requirements for clinical encounters could be understood. The outcome of the formative work was a smartphone application prototype to be used as the treatment in an experimental study. In a mixed methods study, with a patient role-player using the prototype during a simulated clinical encounter with 12 providers, the impact of the prototype upon secondary user satisfaction and common ground was assessed. The main finding was that the prototype was capable of positively impacting secondary user satisfaction and facilitating common ground in certain instances. Combining the notions of human-computer interaction design, common ground, and smartphone technology improved the efficiency and effectiveness of providers during the simulated face-to-face first encounter with a patient. The investigation substantiated the notion that properly designed interactive systems have the potential to provide a satisfactory secondary UX and facilitate common ground.

Indiana University-Purdue University Indianapolis (IUPUI) / Long-term survivors (LTSs) of breast cancer are defined as patients who have been in remission for a year or longer. Even after being declared breast-cancer-free, many LTSs have questions that were not answered by clinicians. Although online resources provide some content for LTSs, none, or very little, provide immediate answers to specific questions. Thus, the aim involves proposing specifications for a system, the Health Electronic Learning Platform (HELP), that can assist survivors by becoming an all-inclusive resource for LTSs of breast cancer. To achieve this, relevant information from the literature was used to assess the needs of LTSs. Also, data from a study involving the breast cancer survivor’s forum project that had been filtered to include posts with mentions of features to be added to the website and usability issues encountered. To complete the actual design of the system, a synthesis of the results obtained from these two sources was performed. HELP is simple in terms of its layout and consists of a main search-bar, where LTSs are able to ask questions using their own terms and language. This navigator should not be taken as definitive solution, but instead, should be used as a starting point toward better patient-centered care.

Indiana University-Purdue University Indianapolis (IUPUI) / Introduction Mobile health (mHealth) applications (apps) are increasingly accessible and popular. In 2015, over 60% of smartphone users used their phones to look up health related information. mHealth apps related to maternal and child health (MCH) are particularly prevalent and frequently used. As high as 73% pregnant women and new mothers reported the use of MCH apps, with 27% using them daily. Methods A cross-sectional sample of MCH apps was extracted from the Apple App and Google Play stores using a JavaScript Scraper program. A multivariable linear regression, and series of ordinal logistic regression assessed the relationship between MCH app characteristics and two outcomes, end users’ perceived satisfaction (star ratings), and intent to use (downloads). Next, theory-based content analysis reviewed the presence and use of behavior change techniques (BCTs) in popular MCH apps using the mHealth app taxonomy framework. Finally, a qualitative inductive analysis assessed user self-reported experiences, perceived benefits, and general feedback for MCH apps. Results Seven hundred and forty-two apps met the inclusion criteria. A large majority of MCH apps were developed by non-healthcare developers. Google Play store apps had higher user ratings; while, apps within health & fitness genre, with older updates, and no agerestrictions had fewer user ratings. Furthermore, lower priced apps, with high star ratings, in-app purchase options, and in-app advertisement presence had high downloads. And, apps belonging to medical and health & fitness genre had fewer user downloads. Content analysis revealed that popular MCH apps on an average include 7.4 behavior change techniques (BCTs) with a median of 6 BCTs. Apps developed by healthcare developers had higher BCTs present within app content. Qualitative analysis shows that consumers value apps that are low cost, with superior features, smooth technical aspects, high quality content, and easy to use. Conclusions Healthcare providers, app developers, and policymakers may benefit from a better understanding of MCH apps available in two popular app stores and may consider strategies to review and promote apps to consumers based on information accuracy and trustworthiness. / 2020-11-06

Indiana University-Purdue University Indianapolis (IUPUI) / The United States has invested over $40 billion in digitizing the health care system, yet the anticipated gains in improved care coordination, quality, and cost savings remain largely unrealized. This is due in part to limited interoperability and low rates of health information exchange (HIE) use, which can support care coordination and improve provider decision-making. Primary care providers are central to the US health care delivery system and frequently function as care coordinators, yet capability and HIE use gaps among these providers limit the potential of these digital systems to achieve their intended goals. I study HIE use in the context of primary care to examine 1) factors associated with provider HIE use, 2) the extent and nature of team-based HIE use, and 3) differences in HIE system use patterns across discrete groups of system users. First, I use a national sample of primary care providers to analyze market and practice factors related to HIE use for patient referrals. Overall, I find that only 43% of primary care provider referrals used HIE. Furthermore, I find substantial variation in HIE use rates across electronic health record (EHR) vendors. Second, I use HIE system log data to understand the breadth and depth of HIE use among teams, a care model underpinning primary care delivery reform efforts. I find that although use of HIE systems remains low, in primary care settings it overwhelmingly takes place in a manner consistent with team-based care workflows. Furthermore, team-based use does not differ in breadth from single provider HIE use, but illustrates less depth before and after visits. Third, I apply cluster analysis to 16 HIE use measures representing 7 use attributes, and identify 5 discrete user groups. I then compare two of these user groups and find user-level variation in volume and efficiency of use, both of which have implications for HIE system design and usability improvements. Ultimately, these findings help to inform how HIE use can be increased and improved in primary care, moving the US health care system closer to realizing the coordination, quality, and cost savings made possible by a digitized delivery system.

The present study investigated the effectiveness of health related feedback as a positive reinforcer of abstinence from smoking during the 11 week period following cessation. Fifty-three subjects were randomly assigned to one of three groups: (a) maintenance program plus health related feedback (MF), (b) maintenance program only (M) and, (c) discussion control (D). All groups received an aversive treatment for smoking after which the MP group received coping skills raining and several forms of health related feedback, the M group received coping skills training only, and the D group received discussion. Groups did not differ significantly in abstinence at each of the 11 weeks.

The present study takes legibility research and extends it to the medical setting. Internal Medicine Physicians from UCF developed six passages of medical text detailing a History of Present Illness (HPI) Report from an emergency department as well as comprehension questions for the purpose of our study. In our study, we first presented non-medical passages and comprehension questions in six common fonts to identify participants' individual fastest and slowest fonts. We then gave participants medical passages in both their best and worst fonts while measuring reading speed and comprehension. This study was delivered to a population of Amazon Mechanical Turk crowd workers to help us better understand how legibility improvements can be made within specific fields. We hope that with this study we can begin the process of restructuring Electronic Health Records to be more usable and efficient for physicians.

The increasing use of health information technology (HIT) is due to a rising interest in improving the quality of health care. HIT has the potential to reduce cost and transform services. Proper clinical support systems will contribute to the meaningful use of HIT systems by providing a wide array of data to clinicians for the diagnosis and treatments. Clinical guidelines, created by a consensus of experts, can be put in place to assist physicians in making clinical decisions. Delphi methods are commonly used to create consensus from surveys completed by a team of experts. Image-based studies could create guidelines that standardize severity, deformity or other clinical classifications. As these studies were traditionally conducted using paper-based media, the cost and time requirement often make the process impractical. Using state of the art Web 2.0 technologies, a web-based system can aid medical researchers in conducting image-based Delphi studies for improved clinical guidelines and decision support.

Effective patient-provider communication (PPC) involves conveying sufficient information to a patient such that the treatment is agreed upon and implemented accurately. Furthermore, a patient must feel adequately involved in the treatment process. With the advent of the COVID-19 pandemic, many clinical visits were shifted online. Although telemedicine was successful in meeting pandemic-specific goals, such as lowering personal contact, it changes the communicative context. Both patients and providers get less input from body language (nonverbal communication) and rely more on verbal communication. Furthermore, the number of telemedicine visits conducted remains elevated over pre-pandemic levels. Much of what is known about effective PPC is derived from studies in in-person contexts, with little information available in virtual contexts. Given that even occasional lapses in optimal PPC can have severe effects on patient outcomes, it is essential to understand PPC in various settings to optimize patient outcomes in the long run. This study was a secondary data analysis of the UCF Student Health Services Patient Satisfaction Questionnaire. A total of 6645 survey results from January 2021 to November 2022 were analyzed to compare patient perceptions of PPC variables and overall satisfaction with the clinical visit. The results indicated that there was no statistically significant difference in overall satisfaction and PPC variables between telemedicine and in-person visits. However, the results revealed that different PPC variables contributed to overall satisfaction with telemedicine and in-person visits. Keywords: patient-provider communication, telemedicine, telehealth, COVID-19, patient satisfaction, college

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