Consumers' Needs for Laboratory Results Portals: Questionnaire Study.

BACKGROUND: Over the last decade, there has been an increase in the number of health care consumers (ie, patients, citizens, and laypeople) with access to their laboratory results through portals. However, many portals are not designed with the consumer in mind, which can limit communication effectiveness and consumer empowerment. OBJECTIVE: We aimed to study design facilitators and barriers affecting consumer use of a laboratory results portal. We sought to identify modifiable design attributes to inform future interface specifications and improve patient safety. METHODS: A web-based questionnaire with open- and closed-ended items was distributed to consumers in British Columbia, Canada. Open-ended items with affinity diagramming and closed-ended questions with descriptive statistics were analyzed. RESULTS: Participants (N=30) preferred reviewing their laboratory results through portals rather than waiting to see their provider. However, respondents were critical of the interface design (ie, interface usability, information completeness, and display clarity). Scores suggest there are display issues impacting communication that require urgent attention. CONCLUSIONS: There are modifiable usability, content, and display issues associated with laboratory results portals that, if addressed, could arguably improve communication effectiveness, patient empowerment, and health care safety.

Why Do People Use Online Lab Results and What Do They Look For: A Qualitative Study.

Laboratory (lab) test results are increasingly available online for patient review. However, there is a dearth of research with respect to users' information needs, goals, and information processing strategies. In this exploratory qualitative study, we interviewed a sample of (N = 25) online lab results users to understand their objectives and search targets. We transcribed their responses and used affinity diagramming to identify themes in their responses. Our analysis identified six reasons why people look at their online lab results (i.e., health status, reassurance, health education, speed, self-management, and patient safety) and two themes about what people look for (i.e., abnormal and normal values, trends). Knowing what drives users and what information they are looking for can inform the design of online lab reporting, improve usefulness, and better satisfy user needs.

Patients' and Providers' Perspectives on and Needs of Telemonitoring to Support Clinical Management and Self-care of People at High Risk for Preeclampsia: Qualitative Study.

BACKGROUND: Preeclampsia is one of the leading causes of maternal mortality worldwide, with a global prevalence at 2%-8% of pregnancies. Patients at high risk for preeclampsia (PHRPE) have an increased risk of complications, such as fetal growth restriction, preterm delivery, abnormal clotting, and liver and kidney disease. Telemonitoring for PHRPE may allow for timelier diagnosis and enhanced management, which may improve maternal and perinatal outcomes. OBJECTIVE: The objective of this study is to determine the perceptions and needs of PHRPE and their health care providers with respect to telemonitoring through semistructured interviews with both groups. This study explored (1) what the needs and challenges of monitoring PHRPE are during pregnancy and in the postpartum period and (2) what features are required in a telemonitoring program to support self-care and clinical management of PHRPE. METHODS: This study used a qualitative descriptive approach, and thematic analysis was conducted. PHRPE and health care providers from a high-risk obstetrical clinic in a large academic hospital in Toronto, Canada, were asked to participate in individual semistructured interviews. Two researchers jointly developed a coding framework and separately coded each interview to ensure that the interviews were double-coded. The software program NVivo version 12 was used to help organize the codes. RESULTS: In total, 7 PHRPE and 5 health care providers, which included a nurse practitioner and physicians, participated in the semistructured interviews. Using thematic analysis, perceptions on the benefits, barriers, and desired features were determined. Perceived benefits of telemonitoring for PHRPE included close monitoring of home blood pressure (BP) measurements and appropriate interventions for abnormal BP readings; the development of a tailored telemonitoring system for pregnant patients; and facilitation of self-management. Perceived barriers to telemonitoring for PHRPE included financial and personal barriers, as well as the potential for increased clinician workload. Desired features of a secure platform for PHRPE included the facilitation of self-management for patients and decision making for clinicians, as well as the inclusion of evidence-based action prompts. CONCLUSIONS: The perceptions of patients and providers on the use of telemonitoring for PHRPE support the need for a telemonitoring program for the management of PHRPE. Recommendations from this study include the specific features of a telemonitoring program for PHRPE, as well as the use of frameworks and design processes in the design and implementation of a telemonitoring program for PHRPE.

A Tale of Two Inspection Methods: Comparing an eHealth Literacy and User Experience Checklist with Heuristic Evaluation.

Adhering to user experience (UX) and eHealth literacy principles when developing consumer health information systems (HISs) can not only improve a user's experience but can also have implications on patient safety. Methods exist to explore these dimensions independently, but few methods are available for evaluating consumer (i.e., citizen) health information systems for their adherence to usability and eHealth literacy design principles simultaneously. In this paper, we compared two inspection (i.e., expert review) tools and identified the strengths and weaknesses of each. The findings from this comparison can assist researchers, consumer health information system developers, and evaluators choosing between the two alternatives. Moreover, our comparison revealed the shortcomings in both tools and the need for a novel, purpose-built tool that is more comprehensive than either of the existing tools that assess UX and eHealth literacy and more adequately address design guidelines for the mobile environment.

A User Experience and eHealth Literacy Inspection of a Lab Test Interpretation Mobile App for Citizens.

People are increasingly able to access their laboratory (lab) results using patient-facing portals. However, lab reports for citizens are often identical to those for clinicians; without specialized training they can be near impossible to interpret. In this study, we inspected a mobile health application (app) that converts traditional lab results into a citizen-centred format. We used the Health Literacy Online (HLO) checklist to inspect the app. Our inspection revealed that most of the app's strengths were related to its Organization of Content and Simple Navigation and most of its weaknesses were related to Engage Users. We also identified several usability and user experience (UX) issues that were beyond the purview of the HLO checklist. Although this app represents an important step towards making lab results universally accessible, we identified several opportunities for improvements that could increase its value to citizens.

COVID-19 Vaccine Hesitancy in Canada: Content Analysis of Tweets Using the Theoretical Domains Framework.

BACKGROUND: With the approval of two COVID-19 vaccines in Canada, many people feel a sense of relief, as hope is on the horizon. However, only about 75% of people in Canada plan to receive one of the vaccines. OBJECTIVE: The purpose of this study is to determine the reasons why people in Canada feel hesitant toward receiving a COVID-19 vaccine. METHODS: We screened 3915 tweets from public Twitter profiles in Canada by using the search words "vaccine" and "COVID." The tweets that met the inclusion criteria (ie, those about COVID-19 vaccine hesitancy) were coded via content analysis. Codes were then organized into themes and interpreted by using the Theoretical Domains Framework. RESULTS: Overall, 605 tweets were identified as those about COVID-19 vaccine hesitancy. Vaccine hesitancy stemmed from the following themes: concerns over safety, suspicion about political or economic forces driving the COVID-19 pandemic or vaccine development, a lack of knowledge about the vaccine, antivaccine or confusing messages from authority figures, and a lack of legal liability from vaccine companies. This study also examined mistrust toward the medical industry not due to hesitancy, but due to the legacy of communities marginalized by health care institutions. These themes were categorized into the following five Theoretical Domains Framework constructs: knowledge, beliefs about consequences, environmental context and resources, social influence, and emotion. CONCLUSIONS: With the World Health Organization stating that one of the worst threats to global health is vaccine hesitancy, it is important to have a comprehensive understanding of the reasons behind this reluctance. By using a behavioral science framework, this study adds to the emerging knowledge about vaccine hesitancy in relation to COVID-19 vaccines by analyzing public discourse in tweets in real time. Health care leaders and clinicians may use this knowledge to develop public health interventions that are responsive to the concerns of people who are hesitant to receive vaccines.

Assessing the quality of mobile applications in chronic disease management: a scoping review.

While there has been a rapid growth of digital health apps to support chronic diseases, clear standards on how to best evaluate the quality of these evolving tools are absent. This scoping review aims to synthesize the emerging field of mobile health app quality assessment by reviewing criteria used by previous studies to assess the quality of mobile apps for chronic disease management. A literature review was conducted in September 2017 for published studies that use a set of quality criteria to directly evaluate two or more patient-facing apps supporting promote chronic disease management. This resulted in 8182 citations which were reviewed by research team members, resulting in 65 articles for inclusion. An inductive coding schema to synthesize the quality criteria utilized by included articles was developed, with 40 unique quality criteria identified. Of the 43 (66%) articles that reported resources used to support criteria selection, 19 (29%) used clinical guidelines, and 10 (15%) used behavior change theory. The most commonly used criteria included the presence of user engagement or behavior change functions (97%, n = 63) and technical features of the app such as customizability (20%, n = 13, while Usability was assessed by 24 studies (36.9%). This study highlights the significant variation in quality criteria employed for the assessment of mobile health apps. Future methods for app evaluation will benefit from approaches that leverage the best evidence regarding the clinical impact and behavior change mechanisms while more directly reflecting patient needs when evaluating the quality of apps.

Exploring the Use of Telemonitoring for Patients at High Risk for Hypertensive Disorders of Pregnancy in the Antepartum and Postpartum Periods: Scoping Review.

BACKGROUND: High blood pressure complicates 2% to 8% of pregnancies, and its complications are present in the antepartum and postpartum periods. Blood pressure during and after pregnancy is routinely monitored during clinic visits. Some guidelines recommend using home blood pressure measurements for the management and treatment of hypertension, with increased frequency of monitoring for high-risk pregnancies. Blood pressure self-monitoring may have a role in identifying those in this high-risk group. Therefore, this high-risk pregnancy group may be well suited for telemonitoring interventions. OBJECTIVE: The aim of this study was to explore the use of telemonitoring in patients at high risk for hypertensive disorders of pregnancy (HDP) during the antepartum and postpartum periods. This paper aims to answer the following question: What is the current knowledge base related to the use of telemonitoring interventions for the management of patients at high risk for HDP? METHODS: A literature review following the methodological framework described by Arksey et al and Levac et al was conducted to analyze studies describing the telemonitoring of patients at high risk for HDP. A qualitative study, observational studies, and randomized controlled trials were included in this scoping review. RESULTS: Of the 3904 articles initially identified, 20 met the inclusion criteria. Most of the studies (13/20, 65%) were published between 2017 and 2018. In total, there were 16 unique interventions described in the 20 articles, all of which provide clinical decision support and 12 of which are also used to facilitate the self-management of HDP. Each intervention's design and process of implementation varied. Overall, telemonitoring interventions for the management of HDP were found to be feasible and convenient, and they were used to facilitate access to health services. Two unique studies reported significant findings for the telemonitoring group, namely, spontaneous deliveries were more likely, and one study, reported in two papers, described inductions as being less likely to occur compared with the control group. However, the small study sample sizes, nonrandomized groups, and short study durations limit the findings from the included articles. CONCLUSIONS: Although current evidence suggests that telemonitoring could provide benefits for managing patients at high risk for HDP, more research is needed to prove its safety and effectiveness. This review proposes four recommendations for future research: (1) the implementation of large prospective studies to establish the safety and effectiveness of telemonitoring interventions; (2) additional research to determine the context-specific requirements and patient suitability to enhance accessibility to healthcare services for remote regions and underserved populations; (3) the inclusion of privacy and security considerations for telemonitoring interventions to better comply with healthcare information regulations and guidelines; and (4) the implementation of studies to better understand the effective components of telemonitoring interventions.

Advancing Telehealth Nursing Practice in Oncology: Factors Affecting Nurse Use of Electronic Symptom Management Guidelines.

Oncology, telehealth nursing practice is growing. There has been an increased use of telehealth systems to support patients living with cancer in the community. In this study we explore the impact of integrating electronic symptom management guidelines (eSMGs) and electronic health records (EHRs) upon oncology, telehealth nursing practice. Ten nurses participated in clinical simulations and post-clinical simulation interviews. Participants' identified that several factors that influenced the use of SMGs including nursing experience and experience in using the eSMGs.

Putting Guidelines in the Hands of Patients: A Heuristic Evaluation of a Consumer Mobile Application.

Preventive clinical practice guidelines are valuable. However, they are often difficult for primary care providers to implement in the time sensitive primary care setting and alternate approaches warrant exploration. An app called CANBeWell was developed in an effort to allow consumers to identify appropriate guidelines for themselves. Two investigators conducted a heuristic evaluation to identify potential eHealth literacy and usability issues. Several recommendations were made to make CANBeWell easier for consumers to use and understand. CANBeWell is a promising app for deploying preventive guidelines directly to health consumers. Usability testing is planned for the next iteration to ensure that this app meets the needs and capabilities of health consumers.

Isolating the Effects of a Mobile Phone on the Usability and Safety of eHealth Software Applications.

Mobile phones are used in conjunction with mobile eHealth software applications. These mobile software applications can be used to access, review and document clinical information. The objective of this research was to explore the relationship between mobile phones, usability and safety. Clinical simulations and semi-structured interviews were used to investigate this relationship. The findings revealed that mobile phones may lead to specific types of usability issues that may introduce some types of errors.

Usability and eHealth Literacy Evaluation of a Mobile Health Application Prototype to Track Diagnostic Imaging Examinations.

In the absence of a pan-Canadian electronic health record, unnecessary duplicate diagnostic imaging (DI) examinations are sometimes ordered when a physician is not aware of prior DI or prior DI is not available. Research suggests that physicians may ask their patient to recall their DI history; however, patient recall of DI can be unreliable. As a potential solution, a patient-facing mobile health application (app) prototype was developed for users to record their DI. The app was designed to be usable and inclusive to users of all health literacy levels. The aim of this paper is to demonstrate how eHealth literacy and usability heuristics can be used during the design phases of app development.

Designing a Mobile Health Application Prototype for the Management of Interstitial Cystitis/Painful Bladder Syndrome.

The design of an early mobile health application (app) prototype to manage interstitial cystitis/painful bladder syndrome, a chronic condition characterized by recurrent pain/discomfort in the bladder and pelvic floor, is described. The purpose of this app prototype is to help people who have IC/PBS manage and learn what triggers their symptoms. Another aim of this research was to provide an example of how sex and gender could be included into the design of a health information system. Based on a literature search of common symptoms and challenges faced by people living with IC/PBS, the researcher created an app prototype design including many features: resources for relaxation, mental health, intimacy, pregnancy, and daily life; reminders for appointments, and medication; logs for diet, activity, sleep, pain, menstruation; and a link to a public washroom locator. This prototype will later undergo usability and content evaluation.

Integrating Electronic Health Record Competencies into Undergraduate Health Informatics Education.

In this paper we report on our findings arising from a qualitative, interview study of students' experiences in an undergraduate health informatics program. Our findings suggest that electronic health record competencies need to be integrated into an undergraduate curriculum. Participants suggested that there is a need to educate students about the use of the EHR, followed by best practices around interface design, workflow, and implementation with this work culminating in students spearheading the design of the technology as part of their educational program of study.

Nurse practitioners changing health behaviours: one patient at a time.

In 2005, legislation was enacted allowing nurse practitioners (NPs) to practise in British Columbia, Canada. Although substantial human and financial resources had been dedicated to the implementation of the role, no evaluation has been conducted to date. As part of a larger multiphase, mixed-methods study design, which evaluated the integration of NPs into the British Columbia healthcare system, this article describes findings related to changes that result for patients and the implications for the healthcare system when NPs become part of the care process. Using survey and interview data, themes that emerged were patient satisfaction, access to care, and behavioural changes. Findings suggest that patients are satisfied with the care they receive from NPs and that NPs make positive changes to health behaviour.

Physician Experiences with Perceived Pressure to Order Diagnostic Imaging Services.

The overuse of diagnostic imaging (DI) services, which is estimated to be 30% in Canada, can expose patients to unnecessary radiation, and strain human and financial resources. This study explored the DI ordering practices of physicians in Canada through semi-structured interviews to gain a deeper understanding of the factors contributing to the overuse of DI services. The majority of participants (n=11; 91%) described feeling pressured by patients to order DI services in circumstances that were unwarranted. The results are followed by a discussion about ways technology (such as a decision support system) could aid in facilitating a dialogue between physicians and patients about when and when not to order DI.

Nurse Practitioner Perceptions of the Impact of Electronic Medical Records Upon Clinical Practice.

A survey was conducted in the province of British Columba, Canada with nurse practitioners (NP). This paper reports on the quantitative and qualitative findings of the survey questions specifically focused on NP perceptions of the clinical impacts associated with using electronic medical records (EMRs) in a primary care setting. Findings suggest that although NPs perceived EMRs to improve the overall quality of clinical decisions, challenges remain in terms of tailoring the design of EMRs to address NP needs.

Mobile Usability Testing in Healthcare: Methodological Approaches.

The use of mobile devices and healthcare applications is increasing exponentially worldwide. This has lead to the need for the healthcare industry to develop a better understanding of the impact of the usability of mobile software and hardware upon consumer and health professional adoption and use of these technologies. There are many methodological approaches that can be employed in conducting usability evaluation of mobile technologies. More obtrusive approaches to collecting study data may lead to changes in study participant behaviour, leading to study results that are less consistent with how the technologies will be used in the real-world. Alternatively, less obstrusive methods used in evaluating the usability of mobile software and hardware in-situ and laboratory settings can lead to less detailed information being collected about how an individual interacts with both the software and hardware. In this paper we review and discuss several innovative mobile usability evaluation methods on a contiuum from least to most obtrusive and their effects on the quality of the usability data collected. The strengths and limitations of methods are also discussed.

Evidence-based Heuristics for Evaluating Demands on eHealth Literacy and Usability in a Mobile Consumer Health Application.

Heuristic evaluations have proven to be valuable for identifying usability issues in systems. Commonly used sets of heuritics exist; however, they may not always be the most suitable, given the specific goal of the analysis. One such example is seeking to evaluate the demands on eHealth literacy and usability of consumer health information systems. In this study, eight essential heuristics and three optional heuristics subsumed from the evidence on eHealth/health literacy and usability were tested for their utility in assessing a mobile blood pressure tracking application (app). This evaluation revealed a variety of ways the design of the app could both benefit and impede users with limited eHealth literacy. This study demonstrated the utility of a low-cost, single evaluation approach for identifying both eHealth literacy and usability issues based on existing evidence in the literature.

Using a mixed-methods design to examine nurse practitioner integration in British Columbia.

AIM: To discuss and provide examples of how mixed-methods research was used to evaluate the integration of nurse practitioners (NPs) into a Canadian province. BACKGROUND: Legislation enabling NPs to practise in British Columbia (BC) was enacted in 2005. This research evaluated the integration of NPs and their effect on the BC healthcare system. DATA SOURCES: Data were collected using surveys, focus groups, participant interviews and case studies over three years. REVIEW METHODS: Data sources and methods were triangulated to determine how the findings addressed the research questions. DISCUSSION: The challenges and benefits of using the multiphase design are highlighted in the paper. CONCLUSION: The multiphase mixed-methods research design was selected because of its applicability to evaluation research. The design proved to be robust and flexible in answering research questions. IMPLICATIONS FOR PRACTICE/RESEARCH: As sub-studies within the multiphase design are often published separately, it can be difficult for researchers to find examples. This paper highlights ways that a multiphase mixed-methods design can be conducted for researchers unfamiliar with the process.