ABSTRACT
BACKGROUND: Few patient engagement tools incorporate the complex patient experiences, contexts, and workflows that limit depression treatment implementation. OBJECTIVE: Describe a user-centered design (UCD) process for operationalizing a preference-driven patient activation tool. DESIGN: Informed by UCD and behavior change/implementation science principles, we designed a preference-driven patient activation prototype for engaging patients in depression treatment. We conducted three usability cycles using different recruitment/implementation approaches: near live/live testing in primary care waiting rooms (V1-2) and lab-based think aloud testing (V3) oversampling older, low-literacy, and Spanish-speaking patients in the community and via EHR algorithms. We elicited clinician and "heuristic" expert input. MAIN MEASURES: We administered the system usability scale (SUS) all three cycles and pre-post V3, the patient activation measure, decisional conflict scale, and depression treatment barriers. We employed descriptive statistics and thematically analyzed observer notes and transcripts for usability constructs. RESULTS: Overall, 43 patients, 3 clinicians, and 5 heuristic (a usability engineering method for identifying usability problems) experts participated. Among patients, 41.9% were ≥ 65 years old, 79.1% female, 23.3% Black, 62.8% Hispanic, and 55.8% Spanish-speaking and 46.5% had ≤ high school education. We described V1-3 usability (67.2, 77.3, 81.8), treatment seeking (92.3%, 87.5%, 92.9%), likelihood/comfort discussing with clinician (76.9%, 87.5%, 100.0%), and pre vs. post decisional conflict (23.7 vs. 15.2), treatment awareness (71.4% vs. 92.9%), interest in antidepressants (7.1% vs. 14.3%), and patient activation (66.8 vs. 70.9), with fewer barriers pertaining to cost/insurance, access/coordination, and self-efficacy/stigma/treatment efficacy. Key themes included digital literacy, understandability, high acceptability for aesthetics, high usefulness of patient/clinician videos, and workflow limitations. We adapted manual entry/visibility/content; added patient activation and a personalized algorithm; and proposed flexible, care manager delivery leveraging clinic screening protocols. DISCUSSION: We provide an example of leveraging UCD to design/adapt a real-world, patient experience and workflow-aligned patient activation tool in diverse populations.
ABSTRACT
The sleep-wake and circadian cycles are influenced by light, particularly in the short-wavelength portion of the visible spectrum. Most personal light-emitting electronic devices are enriched in this so-called "blue" light. Exposure to these devices in the evening can disturb sleep. Interventions to reduce short-wavelength light exposure before bedtime may reduce adverse effects on sleep. We conducted a systematic review and meta-analysis to examine the effect of wearing color-tinted lenses (e.g. orange or amber) in frames to filter short-wavelength light exposure to the eye before nocturnal sleep. Outcomes were self-reported or objective measures of nocturnal sleep. Relatively few (k = 12) studies have been done. Study findings were inconsistent, with some showing benefit and others showing no effect of intervention. Meta-analyses yielded a small-to-medium magnitude combined effect size for sleep efficiency (Hedge's g = 0.31; 95% CI: -0.05, 0.66; I2 = 38.16%; k = 7), and a small-to-medium combined effect size for total sleep time (Hedge's g = 0.32; 95% CI: 0.01, 0.63; I2 = 12.07%; k = 6). For self-report measures, meta-analysis yielded a large magnitude combined effects size for Pittsburgh Sleep Quality Index ratings (Hedge's g = -1.25; 95% CI: -2.39, -0.11; I2 = 36.35%; k = 3) and a medium combined effect size for total sleep time (Hedge's g = 0.51; 95% CI: 0.18, 0.84; I2 = 0%; k = 3), Overall, there is some, albeit mixed, evidence that this approach can improve sleep, particularly in individuals with insomnia, bipolar disorder, delayed sleep phase syndrome, or attention-deficit hyperactive disorder. Considering the ubiquitousness of short-wavelength-enriched light sources, future controlled studies to examine the efficacy of this approach to improve sleep are warranted. Systematic review registration: PROSPERO 2018 CRD42018105854.
ABSTRACT
County based prevalence maps were produced using the annual data from the years 2011 through 2014 of the prevalence of Toxocara egg shedding in more than 500,000 pet cat and 2.5 million pet dog fecal samples submitted to centralized testing laboratories. Fecal examination results were obtained at these centers through examination of the samples by centrifugal floatation and microscopy, and were previously reported as annual data on the Companion Animal Parasite Council (CAPC) website. The county maps were generated with mapping and spatial analysis software, and statistical comparisons made using two data analysis packages. The national prevalence of eggs in the feces of pet cats and dogs during this four-year period was 4.6-5.1% and 1.8-2.0%, respectively. Thus, Toxocara cati and Toxocara canis remain considerably prevalent and geographically distributed in our pet populations in spite of the availability of effective and safe treatments. Furthermore, pet cats are found to be shedding Toxocara eggs more commonly than pet dogs. This trend was especially evident in the Northeastern, Midwestern and Southern regions of the U.S.A. when prevalence rates of fecal shedding for cats and dogs in different regions were compared using general linear modeling. In spite of this, fecal endoparasite examination tests for cats comprise only 16-17.6% of the total number of samples annually requested in this data set. This high prevalence of egg shedding poses a significant public health risk, as emphasized by the recent naming of toxocariasis to the list of the top five neglected parasitic infections of Americans. Therefore, it is essential for veterinarians to continue to stress to owners the importance of routine anthelmintic treatment for pets of all ages, and to place greater emphasis on the importance of testing and treatment of parasitic infections in cats.
