Publications by authors named "Plinio P Morita"

23 Publications

  • Page 1 of 1

Examining the relationships among adolescent health behaviours, prefrontal function, and academic achievement using fNIRS.

Dev Cogn Neurosci 2021 08 1;50:100983. Epub 2021 Jul 1.

School of Public Health Sciences, University of Waterloo, Waterloo, ON, Canada; Department of Psychology, University of Waterloo, Waterloo, ON, Canada; Centre for Bioengineering and Biotechnology, University of Waterloo, Waterloo, Canada. Electronic address:

Several adolescent health behaviours have been hypothesized to improve academic performance via their beneficial impact on cognitive control and functional aspects of the prefrontal cortex (PFC). The primary objective of this study is to examine the association between lifestyle behaviours and academic performance in a sample of adolescents, and to examine the extent to which activity within the PFC and behavioural indices of inhibition may mediate this relationship. Sixty-seven adolescents underwent two study sessions five days apart. Sleep and physical activity were measured using wrist-mounted accelerometry; eating habits, substance use and academic achievement were measured by self-report. Prefrontal function was quantified by Multi-Source Interference Task (MSIT) performance, and task-related activity via functional near-infrared spectroscopy (fNIRS). Higher levels of physical activity predicted higher MSIT accuracy scores (β = .321, ρ = 0.019) as well as greater activation within the right dlPFC (b = .008, SE = .004, ρ = .0322). Frequency of fast-food consumption and substance use were negatively associated with MSIT accuracy scores (β = -0.307, ρ = .023) and Math grades (b = -3.702, SE = 1.563, ρ = .022), respectively. Overall, the results of this study highlight the importance of lifestyle behaviours as predictors of prefrontal function and academic achievement in youth.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.1016/j.dcn.2021.100983DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8280512PMC
August 2021

Biobehavioral Aspects of the COVID-19 Pandemic: A Review.

Psychosom Med 2021 05;83(4):309-321

From the School of Public Health Sciences (Hall, Fong, Oremus, Sakib, Butt, Jandu, Morita) and Department of Psychology (Hall, Fong), University of Waterloo, Waterloo, Ontario, Canada; Department of Psychology and Neuroscience (Sheeran), University of North Carolina at Chapel Hill, Chapel Hill, North Carolina; Ontario Institute for Cancer Research (Fong), Toronto, Ontario, Canada; Department of Psychology (Cheah), University of Maryland, Baltimore County, Baltimore, Maryland; Department of Physical Therapy, Faculty of Medicine (Liu-Ambrose), University of British Columbia, Vancouver, Canada; School of Biomedical Engineering, Science and Health Systems (Ayaz) and Department of Psychology, College of Arts and Sciences (Ayaz), Drexel University; and Department of Family and Community Health (Ayaz), University of Pennsylvania, Philadelphia, Pennsylvania.

Objective: This review highlights the scope and significance of the coronavirus disease 2019 (COVID-19) pandemic with a focus on biobehavioral aspects and critical avenues for research.

Methods: A narrative review of the published research literature was undertaken, highlighting major empirical findings emerging during the first and second waves of the COVID-19 pandemic.

Results: Interactions among biological, behavioral, and societal processes were prominent across all regions of the globe during the first year of the COVID-19 emergency. Affective, cognitive, behavioral, socioeconomic, and technological factors all played a significant role in the spread of infection, response precautions, and outcomes of mitigation efforts. Affective symptoms, suicidality, and cognitive dysfunction have been widely described consequences of the infection, the economic fallout, and the necessary public health mitigation measures themselves. The impact of COVID-19 may be especially serious for those living with severe mental illness and/or chronic medical diseases, given the confluence of several adverse factors in a manner that appears to have syndemic potential.

Conclusions: The COVID-19 pandemic has made clear that biological and behavioral factors interact with societal processes in the infectious disease context. Empirical research examining mechanistic pathways from infection and recovery to immunological, behavioral, and emotional outcomes is critical. Examination of how emotional and behavioral factors relate to the pandemic-both as causes and as effects-can provide valuable insights that can improve management of the current pandemic and future pandemics to come.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.1097/PSY.0000000000000932DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8115744PMC
May 2021

Reference architectures for ambient assisted living: a scoping review protocol.

BMJ Open 2020 10 31;10(10):e033758. Epub 2020 Oct 31.

School of Public Health and Health Systems, University of Waterloo, Waterloo, Ontario, Canada

Introduction: For the first time in human history, the number of older people will be higher than the number of children. The prevalence of chronic diseases, such as hypertension, cardiovascular disease, diabetes and mental disorders in older adults is high. Given that, it is essential to make usage of related technology to provide improved health conditions and reduce the costs for promoting ageing in place, and that is precisely the aim of Ambient Assisted Living technology. Considering that these systems provide significant benefit to a vast number of stakeholders, can be applied to the functional diversity of application domains and have high economic and social impacts, it is essential to create reusable and interoperable platforms and standards that are able to deal with the heterogeneity of applications and domains. In this sense, reference architectures have been proposed and evaluated. A comprehensive scoping review concerning the reference architectures must clarify specific aspects, such as what the main domains are and how the solutions effectively deal with them.

Methods: This scoping review will follow the methodology framework defined in 'Scoping studies: advancing the methodology'. In this methodological framework, six stages are proposed for scoping review studies: identifying the research question; identifying relevant studies; study selection; charting the data; collating, summarising and reporting the results; and consultation. The research questions aim to investigate what are the motivations, stakeholders, benefits, domains, approaches, architectural components and governance aspects of the proposed reference architectures and models. The team will focus on the Scopus Document Search, PubMed (MEDLINE), IEEE Xplore Digital Library, ACM Digital Library and Science Direct electronic research databases. The search query is a combination of terms related to Ambient Assisted Living AND Reference Architecture.

Ethics And Dissemination: This is a scoping review study and there is no requirement for ethical approval, as primary data will not be collected. The results from this scoping review will be published in a peer-reviewed journal and reported at scientific meetings. We intend to share the results with the International Standards and Conformity Assessment - SyC AAL from Canada to use the review as a basis for establishing an assessment model of reference architectures.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.1136/bmjopen-2019-033758DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7783615PMC
October 2020

Overview of Policies, Guidelines, and Standards for Active Assisted Living Data Exchange: Thematic Analysis.

JMIR Mhealth Uhealth 2020 06 22;8(6):e15923. Epub 2020 Jun 22.

School of Public Health and Health Systems, University of Waterloo, Waterloo, ON, Canada.

Background: A primary concern for governments and health care systems is the rapid growth of the aging population. To provide a better quality of life for the elderly, researchers have explored the use of wearables, sensors, actuators, and mobile health technologies. The term AAL can be referred to as active assisted living or ambient assisted living, with both sometimes used interchangeably. AAL technologies describes systems designed to improve the quality of life, aid in independence, and create healthier lifestyles for those who need assistance at any stage of their lives.

Objective: The aim of this study was to understand the standards and policy guidelines that companies use in the creation of AAL technologies and to highlight the gap between available technologies, standards, and policies and what should be available for use.

Methods: A literature review was conducted to identify critical standards and frameworks related to AAL. Interviews with 15 different stakeholders across Canada were carried out to complement this review. The results from interviews were coded using a thematic analysis and then presented in two workshops about standards, policies, and governance to identify future steps and opportunities regarding AAL.

Results: Our study showed that the base technology, standards, and policies necessary for the creation of AAL technology are not the primary problem causing disparity between existing and accessible technologies; instead nontechnical issues and integration between existing technologies present the most significant issue. A total of five themes have been identified for further analysis: (1) end user and purpose; (2) accessibility; (3) interoperability; (4) data sharing; and (5) privacy and security.

Conclusions: Interoperability is currently the biggest challenge for the future of data sharing related to AAL technology. Additionally, the majority of stakeholders consider privacy and security to be the main concerns related to data sharing in the AAL scope. Further research is necessary to explore each identified gap in detail.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.2196/15923DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7338926PMC
June 2020

Feasibility randomised controlled trial of remote symptom chemotherapy toxicity monitoring using the Canadian adapted Advanced Symptom Management System (ASyMS-Can): a study protocol.

BMJ Open 2020 06 17;10(6):e035648. Epub 2020 Jun 17.

Department of Medical Oncology and Hematology, Princess Margaret Cancer Centre, University Health Network, Toronto, Ontario, Canada

Introduction: Technology is emerging as a solution to develop home-based, proactive 'real-time' symptom monitoring and management in cancer care. The Advanced Symptom Monitoring and Management System-Canada (ASyMS-Can) is a remote phone-based symptom management system that enables real-time remote monitoring of systemic chemotherapy toxicities.

Methods And Analysis: This study is an open-label, prospective, mixed-method, Phase II, 2-arm parallel group assignment (ASyMS-Can vs usual care) feasibility study in patients with cancer receiving systemic (neo-adjuvant or adjuvant) chemotherapy at Princess Margaret Cancer Centre. A total of 114 patients will be recruited in oncology clinics prior to initiation of chemotherapy. Patients in both arms will complete a demographic and a set of questionnaires at enrolment, mid and end of treatment. Patients in intervention arm will be provided with an encrypted, secure, preprogrammed ASyMS phone for symptom reporting daily for the first 14 days of each chemotherapy treatment cycle up to sixth cycle (16 weeks). Feasibility metrics (recruitment, retention and protocol adherence) and outcomes to assess impact of ASyMS-Can include symptom severity, emotional distress, quality of life and acceptability to patients and clinicians.

Ethics And Dissemination: The study has received ethical and institutional approvals from the University Health Network. Dissemination will include presentations at national/international conferences, and publications in peer-reviewed journals.

Trial Registration Number: NCT03335189.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.1136/bmjopen-2019-035648DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7313714PMC
June 2020

Intervention and Evaluation of Mobile Health Technologies in Management of Patients Undergoing Chronic Dialysis: Scoping Review.

JMIR Mhealth Uhealth 2020 04 3;8(4):e15549. Epub 2020 Apr 3.

School of Public Health and Health Systems, Faculty of Applied Health Sciences, University of Waterloo, Waterloo, ON, Canada.

Background: Studies have shown the effectiveness and user acceptance of mobile health (mHealth) technologies in managing patients with chronic kidney disease (CKD). However, incorporating mHealth technology into the standard care of patients with CKD still faces many challenges. To our knowledge, there are no reviews on mHealth interventions and their assessments concerning the management of patients undergoing dialysis.

Objective: This study provided a scoping review on existing apps and interventions of mHealth technologies in adult patients undergoing chronic dialysis and identified the gaps in patient outcome assessment of mHealth technologies in the literature.

Methods: We systematically searched PubMed (MEDLINE), Scopus, and the Cumulative Index to Nursing and Allied Health Literature databases, as well as gray literature sources. Two keywords, "mHealth" and "dialysis," were combined to address the main concepts of the objectives. Inclusion criteria were as follows: (1) mHealth interventions, which are on a smartphone, tablet, or web-based portals that are accessible through mobile devices; and (2) adult patients (age ≥18 years) on chronic dialysis. Only English papers published from January 2008 to October 2018 were included. Studies with mHealth apps for other chronic conditions, based on e-consultation or videoconferencing, non-English publications, and review papers were excluded.

Results: Of the 1054 papers identified, 22 met the inclusion and exclusion criteria. Most studies (n=20) were randomized controlled trials and cohort studies. These studies were carried out in 7 countries. The main purposes of these mHealth interventions were as follows: nutrition or dietary self-monitoring (n=7), remote biometric monitoring (n=7), web-based portal (n=4), self-monitoring of in-session dialysis-specific information (n=3), and self-monitoring of lifestyle or behavioral change (n=1). The outcomes of the 22 included studies were organized into five categories: (1) patient satisfaction and acceptance, (2) clinical effectiveness, (3) economic assessment, (4) health-related quality of life, and (5) impact on lifestyle or behavioral change. The mHealth interventions showed neutral to positive results in chronic dialysis patient management, reporting no to significant improvement of dialysis-specific measurements and some components of the overall quality of life assessment. Evaluation of these mHealth interventions consistently demonstrated evidence in patients' satisfaction, high level of user acceptance, and reduced use of health resources and cost savings to health care services. However, there is a lack of studies evaluating safety, organizational, sociocultural, ethical, and legal aspects of mHealth technologies. Furthermore, a comprehensive cost-effectiveness and cost-benefit analysis of adopting mHealth technologies was not found in the literature.

Conclusions: The gaps identified in this study will inform the creation of health policies and organizational support for mHealth implementation in patients undergoing dialysis. The findings of this review will inform the development of a comprehensive service model that utilizes mHealth technologies for home monitoring and self-management of patients undergoing chronic dialysis.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.2196/15549DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7165304PMC
April 2020

The Service of Research Analytics to Optimize Digital Health Evidence Generation: Multilevel Case Study.

J Med Internet Res 2019 11 11;21(11):e14849. Epub 2019 Nov 11.

Institute of Health Policy, Management, and Evaluation, Dalla Lana School of Public Health, University of Toronto, Toronto, ON, Canada.

Background: The widespread adoption of digital health interventions for chronic disease self-management has catalyzed a paradigm shift in the selection of methodologies used to evidence them. Recently, the application of digital health research analytics has emerged as an efficient approach to evaluate these data-rich interventions. However, there is a growing mismatch between the promising evidence base emerging from analytics mediated trials and the complexity of introducing these novel research methods into evaluative practice.

Objective: This study aimed to generate transferable insights into the process of implementing research analytics to evaluate digital health interventions. We sought to answer the following two research questions: (1) how should the service of research analytics be designed to optimize digital health evidence generation? and (2) what are the challenges and opportunities to scale, spread, and sustain this service in evaluative practice?

Methods: We conducted a qualitative multilevel embedded single case study of implementing research analytics in evaluative practice that comprised a review of the policy and regulatory climate in Ontario (macro level), a field study of introducing a digital health analytics platform into evaluative practice (meso level), and interviews with digital health innovators on their perceptions of analytics and evaluation (microlevel).

Results: The practice of research analytics is an efficient and effective means of supporting digital health evidence generation. The introduction of a research analytics platform to evaluate effective engagement with digital health interventions into a busy research lab was ultimately accepted by research staff, became routinized in their evaluative practice, and optimized their existing mechanisms of log data analysis and interpretation. The capacity for research analytics to optimize digital health evaluations is highest when there is (1) a collaborative working relationship between research client and analytics service provider, (2) a data-driven research agenda, (3) a robust data infrastructure with clear documentation of analytic tags, (4) in-house software development expertise, and (5) a collective tolerance for methodological change.

Conclusions: Scientific methods and practices that can facilitate the agile trials needed to iterate and improve digital health interventions warrant continued implementation. The service of research analytics may help to accelerate the pace of digital health evidence generation and build a data-rich research infrastructure that enables continuous learning and evaluation.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.2196/14849DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6878108PMC
November 2019

Disruptive Technologies for Environment and Health Research: An Overview of Artificial Intelligence, Blockchain, and Internet of Things.

Int J Environ Res Public Health 2019 10 11;16(20). Epub 2019 Oct 11.

School of Public Health and Health Systems, University of Waterloo, Waterloo, ON N2L 3G1, Canada.

The purpose of this descriptive research paper is to initiate discussions on the use of innovative technologies and their potential to support the research and development of pan-Canadian monitoring and surveillance activities associated with environmental impacts on health and within the health system. Its primary aim is to provide a review of disruptive technologies and their current uses in the environment and in healthcare. Drawing on extensive experience in population-level surveillance through the use of technology, knowledge from prior projects in the field, and conducting a review of the technologies, this paper is meant to serve as the initial steps toward a better understanding of the research area. In doing so, we hope to be able to better assess which technologies might best be leveraged to advance this unique intersection of health and environment. This paper first outlines the current use of technologies at the intersection of public health and the environment, in particular, Artificial Intelligence (AI), Blockchain, and the Internet of Things (IoT). The paper provides a description for each of these technologies, along with a summary of their current applications, and a description of the challenges one might face with adopting them. Thereafter, a high-level reference architecture, that addresses the challenges of the described technologies and could potentially be incorporated into the pan-Canadian surveillance system, is conceived and presented.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.3390/ijerph16203847DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6843531PMC
October 2019

Supporting the Establishment of New Home Dialysis Programs Through the Explore Home Dialysis Program.

Kidney Int Rep 2019 Feb 29;4(2):293-300. Epub 2018 Oct 29.

Division of Nephrology, Toronto General Hospital, University Health Network, Toronto, Ontario, Canada.

Introduction: The globally increasing prevalence of chronic kidney disease has resulted in an ever-growing demand for renal replacement therapy. Although programs are present around the world, there is a paucity of immersive educational programs that train clinicians and administrators to develop new home dialysis programs. Explore Home Dialysis (EHD) is a program created to fill this gap.

Methods: We present the results of the evaluation of the EHD program. Our team interviewed 23 clinicians and administrators who participated in the EHD program. We also assessed country-specific needs and challenges associated with home dialysis.

Results: The 4 main findings include (i) the evaluation of the effectiveness of the EHD program; (ii) the need for an educational program to train individuals on how to deploy home dialysis programs; (iii) evidence that such an educational program is beneficial to participants and for the establishment of new home dialysis programs; and (iv) the identification of barriers to the development of home dialysis programs in countries represented in this study. The data show an increased demand, with strong patient and provider interest in establishing new programs, interest in accessing resources to train clinical and administrative staff in how to run a home dialysis program, and positive feedback about the EHD program in general.

Conclusions: The data from this study were used in the next iteration of the EHD program, to inform clinicians about challenges in the deployment of new home dialysis programs, and to present educational resources that need to be developed in the future.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.1016/j.ekir.2018.10.019DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6365366PMC
February 2019

A Library of Analytic Indicators to Evaluate Effective Engagement with Consumer mHealth Apps for Chronic Conditions: Scoping Review.

JMIR Mhealth Uhealth 2019 01 18;7(1):e11941. Epub 2019 Jan 18.

Institute of Health Policy, Management and Evaluation, Dalla Lana School of Public Health, University of Toronto, Toronto, ON, Canada.

Background: There is mixed evidence to support current ambitions for mobile health (mHealth) apps to improve chronic health and well-being. One proposed explanation for this variable effect is that users do not engage with apps as intended. The application of analytics, defined as the use of data to generate new insights, is an emerging approach to study and interpret engagement with mHealth interventions.

Objective: This study aimed to consolidate how analytic indicators of engagement have previously been applied across clinical and technological contexts, to inform how they might be optimally applied in future evaluations.

Methods: We conducted a scoping review to catalog the range of analytic indicators being used in evaluations of consumer mHealth apps for chronic conditions. We categorized studies according to app structure and application of engagement data and calculated descriptive data for each category. Chi-square and Fisher exact tests of independence were applied to calculate differences between coded variables.

Results: A total of 41 studies met our inclusion criteria. The average mHealth evaluation included for review was a two-group pretest-posttest randomized controlled trial of a hybrid-structured app for mental health self-management, had 103 participants, lasted 5 months, did not provide access to health care provider services, measured 3 analytic indicators of engagement, segmented users based on engagement data, applied engagement data for descriptive analyses, and did not report on attrition. Across the reviewed studies, engagement was measured using the following 7 analytic indicators: the number of measures recorded (76%, 31/41), the frequency of interactions logged (73%, 30/41), the number of features accessed (49%, 20/41), the number of log-ins or sessions logged (46%, 19/41), the number of modules or lessons started or completed (29%, 12/41), time spent engaging with the app (27%, 11/41), and the number or content of pages accessed (17%, 7/41). Engagement with unstructured apps was mostly measured by the number of features accessed (8/10, P=.04), and engagement with hybrid apps was mostly measured by the number of measures recorded (21/24, P=.03). A total of 24 studies presented, described, or summarized the data generated from applying analytic indicators to measure engagement. The remaining 17 studies used or planned to use these data to infer a relationship between engagement patterns and intended outcomes.

Conclusions: Although researchers measured on average 3 indicators in a single study, the majority reported findings descriptively and did not further investigate how engagement with an app contributed to its impact on health and well-being. Researchers are gaining nuanced insights into engagement but are not yet characterizing effective engagement for improved outcomes. Raising the standard of mHealth app efficacy through measuring analytic indicators of engagement may enable greater confidence in the causal impact of apps on improved chronic health and well-being.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.2196/11941DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6356188PMC
January 2019

Usability Evaluation of a Mobile Phone-Based System for Remote Monitoring and Management of Chemotherapy-Related Side Effects in Cancer Patients: Mixed-Methods Study.

JMIR Cancer 2018 Dec 21;4(2):e10932. Epub 2018 Dec 21.

The Lawrence S Bloomberg Faculty of Nursing, University of Toronto, Toronto, ON, Canada.

Background: As most chemotherapy is administered in the outpatient setting, patients are required to manage related side effects at home without direct support from health professionals. The Advanced Symptom Management System (ASyMS) has been developed to facilitate the remote monitoring and management of chemotherapy-related toxicity in patients with cancer, using patient-reported outcomes questionnaires and a clinician alerting system.

Objective: This study aims to evaluate the usability of the ASyMS, a mobile phone-based technology, from the perspective of Canadian patients with cancer receiving chemotherapy to identify existing design, functionality, and usability issues and elicit their views, experiences, and satisfaction with the ASyMS.

Methods: We used a mixed-method approach to data collection with user-based testing, a think-aloud technique, semistructured interviews, and short answer questionnaires with a purposive sample of 10 patients with cancer. Participants attended usability testing sessions at the Centre for Global eHealth Innovation, University Health Network, and performed specific tasks on the ASyMS device. The test was videorecorded and each task was timed during the test. After the usability sessions, participants completed a posttest questionnaire and participated in a semistructured qualitative interview. A thematic analysis was used to code and categorize the identified issues into themes that summarized the type and frequency of occurrence.

Results: The thematic analysis generated 3 overarching themes as follows: ASyMS user-friendliness; usefulness of ASyMS (content quality and richness); and intention to use. Results from the posttest questionnaire indicated that 80% (8/10) of participants had great motivation to use the ASyMS, 70% (7/10) had positive perceptions of the successful use of the ASyMS, and all (10/10, 100%) had a positive attitude toward using the ASyMS in the future. Most identified design and functionality issues were related to the navigation of the ASyMS device and a desire for a more attractive design with advanced functionality and features. The main general design recommendations were as follows: enhance the readability of the screen; implement advance options (eg, search option); and support better navigation.

Conclusions: The ASyMS has shown positive perceptions of patients in usability testing and qualitative interviews. An evaluation of the effects of the ASyMS on symptom outcomes in a clinical trial is needed.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.2196/10932DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6320433PMC
December 2018

An Analytics Platform to Evaluate Effective Engagement With Pediatric Mobile Health Apps: Design, Development, and Formative Evaluation.

JMIR Mhealth Uhealth 2018 Dec 21;6(12):e11447. Epub 2018 Dec 21.

Institute of Health Policy, Management and Evaluation, Dalla Lana School of Public Health, University of Toronto, Toronto, ON, Canada.

Background: Mobile health (mHealth) apps for pediatric chronic conditions are growing in availability and challenge investigators to conduct rigorous evaluations that keep pace with mHealth innovation. Traditional research methods are poorly suited to operationalize the agile, iterative trials required to evidence and optimize these digitally mediated interventions.

Objective: We sought to contribute a resource to support the quantification, analysis, and visualization of analytic indicators of effective engagement with mHealth apps for chronic conditions.

Methods: We applied user-centered design methods to design and develop an Analytics Platform to Evaluate Effective Engagement (APEEE) with consumer mHealth apps for chronic conditions and implemented the platform to analyze both retrospective and prospective data generated from a smartphone-based pain self-management app called iCanCope for young people with chronic pain.

Results: Through APEEE, we were able to automate the process of defining, operationalizing, and evaluating effective engagement with iCanCope. Configuring the platform to integrate with the app was feasible and provided investigators with a resource to consolidate, analyze, and visualize engagement data generated by participants in real time. Preliminary efforts to evaluate APEEE showed that investigators perceived the platform to be an acceptable evaluative resource and were satisfied with its design, functionality, and performance. Investigators saw potential in APEEE to accelerate and augment evidence generation and expressed enthusiasm for adopting the platform to support their evaluative practice once fully implemented.

Conclusions: Dynamic, real-time analytic platforms may provide investigators with a powerful means to characterize the breadth and depth of mHealth app engagement required to achieve intended health outcomes. Successful implementation of APEEE into evaluative practice may contribute to the realization of effective and evidence-based mHealth care.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.2196/11447DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6320392PMC
December 2018

Design and evaluation of a safety-centered user interface for radiation therapy.

Pract Radiat Oncol 2018 Sep - Oct;8(5):e346-e354. Epub 2018 Feb 4.

Healthcare Human Factors, Techna Institute, University Health Network, Toronto, Canada; Institute of Biomaterials and Biomedical Engineering, University of Toronto, Toronto, Canada; Institute of Health Policy, Management and Evaluation, Dalla Lana School of Public Health, University of Toronto, Toronto, Canada.

Purpose: As radiation therapy treatment grows more complex over time, treatment delivery has become more susceptible to adverse events and patient safety risks from use error. The radiation therapy monitoring and treatment delivery user interface explored in this study was redesigned using ecological interface design, a human factors engineering method, and evaluated to improve treatment safety.

Methods And Materials: An initial design concept was created based on previously completed analysis and informally evaluated in focus groups with radiation therapists. Sixteen newly graduated radiation therapists used both the redesigned and current system in a usability test to determine if the redesigned system better supported detection of errors.

Results: The redesigned system successfully improved the error detection rate of 2 errors: wrong treatment volume and wrong treatment site (P < .03 and P < .01, respectively). It also improved level 2 and level 3 situation awareness (ie, comprehension of the meaning of the information and the projection of the behavior of the technology: P < .01 and P < .01, respectively) and achieved a higher user satisfaction.

Conclusions: The ecological interface design approach was found to be effective in redesigning a radiation therapy treatment delivery interface. Radiation therapists were able to deliver simulated radiation therapy with a higher rate of error detection and improved higher-level situation awareness, and participants preferred the redesigned interface to the current interface. Overall, the redesigned interface improved the radiation therapists' system understanding and ability to detect errors that affect patient safety.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.1016/j.prro.2018.01.009DOI Listing
November 2018

Who Is Responsible for Mitigating Work Fatigue of Critical Care Clinicians-the Individual or the System?

Ann Am Thorac Soc 2016 09;13(9):1453-5

5 Department of Anesthesiology and Critical Care, Center for Perioperative Outcomes Research and Transformation, Perelman School of Medicine, and.

View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.1513/AnnalsATS.201606-517EDDOI Listing
September 2016

The usability of ventilators: a comparative evaluation of use safety and user experience.

Crit Care 2016 Aug 20;20:263. Epub 2016 Aug 20.

Healthcare Human Factors, Techna Institute, University Health Network, Toronto, Canada.

Background: The design complexity of critical care ventilators (CCVs) can lead to use errors and patient harm. In this study, we present the results of a comparison of four CCVs from market leaders, using a rigorous methodology for the evaluation of use safety and user experience of medical devices.

Methods: We carried out a comparative usability study of four CCVs: Hamilton G5, Puritan Bennett 980, Maquet SERVO-U, and Dräger Evita V500. Forty-eight critical care respiratory therapists participated in this fully counterbalanced, repeated measures study. Participants completed seven clinical scenarios composed of 16 tasks on each ventilator. Use safety was measured by percentage of tasks with use errors or close calls (UE/CCs). User experience was measured by system usability and workload metrics, using the Post-Study System Usability Questionnaire (PSSUQ) and the National Aeronautics and Space Administration Task Load Index (NASA-TLX).

Results: Nine of 18 post hoc contrasts between pairs of ventilators were significant after Bonferroni correction, with effect sizes between 0.4 and 1.09 (Cohen's d). There were significantly fewer UE/CCs with SERVO-U when compared to G5 (p = 0.044) and V500 (p = 0.020). Participants reported higher system usability for G5 when compared to PB980 (p = 0.035) and higher system usability for SERVO-U when compared to G5 (p < 0.001), PB980 (p < 0.001), and V500 (p < 0.001). Participants reported lower workload for G5 when compared to PB980 (p < 0.001) and lower workload for SERVO-U when compared to PB980 (p < 0.001) and V500 (p < 0.001). G5 scored better on two of nine possible comparisons; SERVO-U scored better on seven of nine possible comparisons. Aspects influencing participants' performance and perception include the low sensitivity of G5's touchscreen and the positive effect from the quality of SERVO-U's user interface design.

Conclusions: This study provides empirical evidence of how four ventilators from market leaders compare and highlights the importance of medical technology design. Within the boundaries of this study, we can infer that SERVO-U demonstrated the highest levels of use safety and user experience, followed by G5. Based on qualitative data, differences in outcomes could be explained by interaction design, quality of hardware components used in manufacturing, and influence of consumer product technology on users' expectations.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.1186/s13054-016-1431-1DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC4992292PMC
August 2016

Personal Protective Equipment for Infectious Disease Preparedness: A Human Factors Evaluation.

Infect Control Hosp Epidemiol 2016 09 13;37(9):1022-8. Epub 2016 Jun 13.

6Infection Prevention and Control Unit,University Health Network,Toronto,Canada.

OBJECTIVE To identify issues during donning and doffing of personal protective equipment (PPE) for infectious diseases and to inform PPE procurement criteria and design. DESIGN A mixed methods approach was used. Usability testing assessed the appropriateness, potential for errors, and ease of use of various combinations of PPE. A qualitative constructivist approach was used to analyze participant feedback. SETTING Four academic health sciences centers: 2 adult hospitals, 1 trauma center, and 1 pediatric hospital, in Toronto, Canada. PARTICIPANTS Participants (n=82) were representative of the potential users of PPE within Western healthcare institutions. RESULTS None of the tested combinations provided a complete solution for PPE. Environmental factors, such as anteroom layout, and the design of protocols and instructional material were also found to impact safety. The study identified the need to design PPE as a complete system, rather than mixing and matching components. CONCLUSIONS Healthcare institutions are encouraged to use human factors methods to identify risk and failure points with the usage of their selected PPE, and to modify on the basis of iterative evaluations with representative end users. Manufacturers of PPE should consider usability when designing the next generation of PPE. Infect Control Hosp Epidemiol 2016;37:1022-1028.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.1017/ice.2016.124DOI Listing
September 2016

Development of a Wearable Cardiac Monitoring System for Behavioral Neurocardiac Training: A Usability Study.

JMIR Mhealth Uhealth 2016 Apr 22;4(2):e45. Epub 2016 Apr 22.

Institute of Biomaterials and Biomedical Engineering, Faculty of Medicine, University of Toronto, Toronto, ON, Canada.

Background: Elevated blood pressure is one of the main risk factors for death globally. Behavioral neurocardiac training (BNT) is a complementary approach to blood pressure and stress management that is intended to exercise the autonomic reflexes, improve stress recovery, and lower blood pressure. BNT involves cognitive-behavioral therapy with a paced breathing technique and heart rate variability biofeedback. BNT is limited to in-clinic delivery and faces an accessibility barrier because of the need for clinical oversight and the use of complex monitoring tools.

Objective: The objective of this project was to design, develop, and evaluate a wearable electrocardiographic (ECG) sensor system for the delivery of BNT in a home setting.

Methods: The wearable sensor system, Beat, consists of an ECG sensor and a mobile app. It was developed iteratively using the principles of test-driven Agile development and user-centered design. A usability study was conducted at Toronto General Hospital to evaluate feasibility and user experience and identify areas of improvement.

Results: The Beat sensor was designed as a modular patch to be worn on the user's chest and uses standard ECG electrodes. It streams a single-lead ECG wirelessly to a mobile phone using Bluetooth Low Energy. The use of small, low-power electronics, a low device profile, and a tapered enclosure allowed for a device that can be unobtrusively worn under clothing. The sensor was designed to operate with a mobile app that guides users through the BNT exercises to train them to a slow-paced breathing technique for stress recovery. The BNT app uses the ECG captured by the sensor to provide heart rate variability biofeedback in the form of a real-time heart rate waveform to complement and reinforce the impact of the training. Usability testing (n=6) indicated that the overall response to the design and user experience of the system was perceived positively. All participants indicated that the system had a positive effect on stress management and that they would use it at home. Areas of improvement were identified, which focused primarily on the delivery of training and education on BNT through the app.

Conclusions: The outcome of this project was a wearable sensor system to deliver BNT at home. The system has the potential to offer a complementary approach to blood pressure and stress management at home and reduce current accessibility barriers.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.2196/mhealth.5288DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC4859872PMC
April 2016

In the Loop: The Organization of Team-Based Communication in a Patient-Centered Clinical Collaboration System.

JMIR Hum Factors 2016 Mar 24;3(1):e12. Epub 2016 Mar 24.

Temmy Latner Centre for Palliative Care, Mount Sinai Hospital, Toronto, ON, Canada.

Background: We describe the development and evaluation of a secure Web-based system for the purpose of collaborative care called Loop. Loop assembles the team of care with the patient as an integral member of the team in a secure space.

Objective: The objectives of this paper are to present the iterative design of the separate views for health care providers (HCPs) within each patient's secure space and examine patients', caregivers', and HCPs' perspectives on this separate view for HCP-only communication.

Methods: The overall research program includes cycles of ethnography, prototyping, usability testing, and pilot testing. This paper describes the usability testing phase that directly informed development. A descriptive qualitative approach was used to analyze participant perspectives that emerged during usability testing.

Results: During usability testing, we sampled 89 participants from three user groups: 23 patients, 19 caregivers, and 47 HCPs. Almost all perspectives from the three user groups supported the need for an HCP-only communication view. In an earlier prototype, the visual presentation caused confusion among HCPs when reading and composing messages about whether a message was visible to the patient. Usability testing guided us to design a more deliberate distinction between posting in the Patient and Team view and the Health Care Provider Only view at the time of composing a message, which once posted is distinguished by an icon.

Conclusions: The team made a decision to incorporate an HCP-only communication view based on findings during earlier phases of work. During usability testing we tested the separate communication views, and all groups supported this partition. We spent considerable effort designing the partition; however, preliminary findings from the next phase of evaluation, pilot testing, show that the Patient and Team communication is predominantly being used. This demonstrates the importance of a subsequent phase of the clinical trial of Loop to validate the concept and design.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.2196/humanfactors.4996DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC4811668PMC
March 2016

Challenges and Paradoxes of Human Factors in Health Technology Design.

JMIR Hum Factors 2016 Mar 1;3(1):e11. Epub 2016 Mar 1.

Healthcare Human Factors, Techna Institute, University Health Network, Toronto, ON, Canada.

Usability testing allows human factors professionals to identify and mitigate issues with the design and use of medical technology. The test results, however, can be paradoxical and therefore be misinterpreted, limiting their usefulness. The paradoxical findings can lead to products that are not aligned with the needs and constraints of their users. We herein report on our observations of the paradox of expertise, the paradox of preference versus performance, and the paradox of choice. Each paradox explored is in the perspective of the design of medical technology, the issues that need to be considered in the interpretation of the test results, as well as suggestions on how to avoid the pitfalls in the design of medical technology. Because these paradoxes can influence product design at various stages of product development, it is important to be aware of the effects to interpret the findings properly.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.2196/humanfactors.4653DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC4811664PMC
March 2016

Uptake of a Consumer-Focused mHealth Application for the Assessment and Prevention of Heart Disease: The <30 Days Study.

JMIR Mhealth Uhealth 2016 Mar 24;4(1):e32. Epub 2016 Mar 24.

Centre for Global eHealth Innovation, Techna Institute, University Health Network, Toronto, ON, Canada.

Background: Lifestyle behavior modification can reduce the risk of cardiovascular disease, one of the leading causes of death worldwide, by up to 80%. We hypothesized that a dynamic risk assessment and behavior change tool delivered as a mobile app, hosted by a reputable nonprofit organization, would promote uptake among community members. We also predicted that the uptake would be influenced by incentives offered for downloading the mobile app.

Objective: The primary objective of our study was to evaluate the engagement levels of participants using the novel risk management app. The secondary aim was to assess the effect of incentives on the overall uptake and usage behaviors.

Methods: We publicly launched the app through the iTunes App Store and collected usage data over 5 months. Aggregate information included population-level data on download rates, use, risk factors, and user demographics. We used descriptive statistics to identify usage patterns, t tests, and analysis of variance to compare group means. Correlation and regression analyses determined the relationship between usage and demographic variables.

Results: We captured detailed mobile usage data from 69,952 users over a 5-month period, of whom 23,727 (33.92%) were registered during a 1-month AIR MILES promotion. Of those who completed the risk assessment, 73.92% (42,380/57,330) were female, and 59.38% (34,042/57,330) were <30 years old. While the older demographic had significantly lower uptake than the younger demographic, with only 8.97% of users aged ≥51 years old downloading the app, the older demographic completed more challenges than their younger counterparts (F8, 52,422 = 55.10, P<.001). In terms of engagement levels, 84.94% (44,537/52,431) of users completed 1-14 challenges over a 30-day period, and 10.03% (5,259/52,431) of users completed >22 challenges. On average, users in the incentives group completed slightly more challenges during the first 30 days of the intervention (mean 7.9, SD 0.13) than those in the nonincentives group (mean 6.1, SD 0.06, t28870=-12.293, P<.001, d=0.12, 95% CI -2.02 to -1.47). The regression analysis suggested that sex, age group, ethnicity, having 5 of the risk factors (all but alcohol), incentives, and the number of family histories were predictors of the number of challenges completed by a user (F14, 56,538 = 86.644, P<.001, adjusted R(2) = .021).

Conclusion: While the younger population downloaded the app the most, the older population demonstrated greater sustained engagement. Behavior change apps have the potential to reach a targeted population previously thought to be uninterested in or unable to use mobile apps. The development of such apps should assume that older adults will in fact engage if the behavior change elements are suitably designed, integrated into daily routines, and tailored. Incentives may be the stepping-stone that is needed to guide the general population toward preventative tools and promote sustained behavior change.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.2196/mhealth.4730DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC4824871PMC
March 2016

Technological aspects of hospital communication challenges: an observational study.

Int J Qual Health Care 2015 Jun 7;27(3):183-8. Epub 2015 Apr 7.

Centre for Global eHealth Innovation, University Health Network, Toronto, ON, Canada M5G 2C4 Institute of Health Policy, Management and Evaluation, University of Toronto, Toronto, ON, Canada.

Objective: To gain insights into how technological communication tools impact effective communication among clinicians, which is critical for patient safety.

Design: This multi-site observational study analyzes inter-clinician communication and interaction with information technology, with a focus on the critical process of patient transfer from the Emergency Department to General Internal Medicine.

Setting: Mount Sinai Hospital, Sunnybrook Health Sciences Centre and Toronto General Hospital.

Participants: At least five ED and general internal medicine nurses and physicians directly involved in patient transfers were observed on separate occasions at each institution.

Interventions: N/A.

Main Outcome Measures: N/A.

Results: The study provides insight into clinician workflow, evaluates current hospital communication systems and identifies key issues affecting communication: interruptions, issues with numeric pagers, lack of integrated communication tools, lack of awareness of consultation status, inefficiencies related to the paper chart, unintuitive user interfaces, mixed use of electronic and paper systems and lack of up-to-date contact information. It also identifies design trade-offs to be negotiated: synchronous communication vs. reducing interruptions, notification of patient status vs. reducing interruptions and speed vs. quality of handovers.

Conclusions: The issues listed should be considered in the design of new technology for hospital communications.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.1093/intqhc/mzv016DOI Listing
June 2015

Situation awareness and risk management understanding the notification issues.

Stud Health Technol Inform 2011 ;164:372-6

Department of Systems Design Engineering - University of Waterloo.

Healthcare institutions are known to be risky environments that still lag behind other industries in the development and application of risk management tools. Awareness of risk is an important aspect of a risk management program. People depend on high awareness to take precautions to manage risk. The Situation Awareness framework describes how a person perceives elements of the environment, comprehends and projects its actions into the future, and analyzes the cognitive process used. Consequently, it allows the integration of the cognitive model and the risk assessment model into one single framework, provides a means of examining if the risk awareness is calibrated to the true risk levels of the institutions, and a better understanding of the issues with adverse events notification systems. In this paper we discuss how the situation awareness model can be used in the assessment of risk awareness, for understanding risk awareness and safety culture, and finally, for designing more effective risk management systems. For the purpose of this paper, we focus on the adverse event notification system.
View Article and Find Full Text PDF

Download full-text PDF

Source
June 2011

Occurrence detection and selection procedures in healthcare facilities: a comparison across Canada and Brazil.

Stud Health Technol Inform 2011 ;164:232-7

Department of Systems Design Engineering - University of Waterloo.

Healthcare institutions face high levels of risk on a daily basis. Efforts have been made to address these risks and turn this complex environment into a safer environment for patients, staff, and visitors. However, healthcare institutions need more advanced risk management tools to achieve the safety levels currently seen in other industries. One of these potential tools is occurrence investigation systems. In order to be investigated, occurrences must be detected and selected for investigation, since not all institutions have enough resources to investigate all occurrences. A survey was conducted in healthcare institutions in Canada and Brazil to evaluate currently used risk management tools, the difficulties faced, and the possibilities for improvement. The findings include detectability difficulties, lack of resources, lack of support, and insufficient staff involvement.
View Article and Find Full Text PDF

Download full-text PDF

Source
June 2011
-->