Browsing by Author "Schnall, Rebecca"
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- ItemAssessment of the Health IT Usability Evaluation Model (Health-ITUEM) for evaluating mobile health (mHealth) technology.(2013-11-27) Brown, William; Yen, Po-Yin; Rojas, Marlene; Schnall, RebeccaBACKGROUND Over two decades of research has been conducted using mobile devices for health related behaviors yet many of these studies lack rigor There are few evaluation frameworks for assessing the usability of mHealth which is critical as the use of this technology proliferates As the development of interventions using mobile technology increase future work in this domain necessitates the use of a rigorous usability evaluation framework METHODS We used two exemplars to assess the appropriateness of the Health IT Usability Evaluation Model Health ITUEM for evaluating the usability of mHealth technology In the first exemplar we conducted 6 focus group sessions to explore adolescents use of mobile technology for meeting their health Information needs In the second exemplar we conducted 4 focus group sessions following an Ecological Momentary Assessment study in which 60 adolescents were given a smartphone with pre installed health related applications apps DATA ANALYSIS We coded the focus group data using the 9 concepts of the Health ITUEM Error prevention Completeness Memorability Information needs Flexibility Customizability Learnability Performance speed Competency Other outcomes To develop a finer granularity of analysis the nine concepts were broken into positive negative and neutral codes A total of 27 codes were created Two raters R1 and R2 initially coded all text and a third rater R3 reconciled coding discordance between raters R1 and R2 RESULTS A total of 133 codes were applied to Exemplar 1 In Exemplar 2 there were a total of 286 codes applied to 195 excerpts Performance speed Other outcomes and Information needs were among the most frequently occurring codes CONCLUSION Our two exemplars demonstrated the appropriateness and usefulness of the Health ITUEM in evaluating mobile health technology Further assessment of this framework with other study populations should consider whether Memorability and Error prevention are necessary to include when evaluating mHealth technology
- ItemmHealth Technology as a Persuasive Tool for Treatment, Care and Management of Persons Living with HIV.(2015-07-09) Schnall, Rebecca; Bakken, Suzanne; Rojas, Marlene; Travers, Jasmine; Carballo-Dieguez, AlexMobile health mHealth technology can be a valuable tool in the management of chronic illnesses including HIV Qualitative research methods were used to identify the desired content and features of a mobile app for meeting and improving the healthcare needs of persons living with HIV PLWH We conducted six focus group sessions with 50 English or Spanish speaking PLWH in New York City To inform data analysis and to illustrate how mHealth technology can be used as a persuasive strategy for improving the health of PLWH we integrated Fogg s functional role triad for computing technology model with the self determination theory to illustrate how mHealth technology can be used as a persuasive strategy for improving the health of PLWH Participants suggested several tools for meeting their healthcare needs including reminders alerts lab results tracking and notes on health status mHealth technology can function as a social actor by providing chat boxes forums testimonials of lived experiences and personal outreach Examples of media that can be used as a persuasive technology include games virtual rewards coding of health tasks and simulations on how to connect with PLWH Findings from these focus groups can be used to design a mobile app for PLWH that is targeted to meet their healthcare needs
- ItemA Mobile Health Intervention for HIV Prevention Among Racially and Ethnically Diverse Young Men: Usability Evaluation.(0000-00-00) Cho, Hwayoung; Powell, Dakota; Pichon, Adrienne; Thai, Jennie; Bruce, Josh; Kuhns, Lisa M; Garofalo, Robert; Schnall, RebeccaBACKGROUND Mobile health mHealth apps have the potential to be a useful mode of delivering HIV prevention information particularly for young men 13 24 years who account for 21 of new HIV diagnoses in the United States We translated an existing evidence based face to face HIV prevention curriculum into a portable platform and developed a mobile Web app MyPEEPS Mobile OBJECTIVE The purpose of this study was to assess the usability of MyPEEPS Mobile from both expert and end user perspectives METHODS We conducted a heuristic evaluation with five experts in informatics to identify violations of usability principles and end user usability testing with 20 young men aged 15 to 18 years in New York NY Birmingham AL and Chicago IL to identify potential obstacles to their use of the app RESULTS Mean scores of the overall severity of the identified heuristic violations rated by experts ranged from 0 4 and 2 6 0 no usability problem to 4 usability catastrophe Overall our end users successfully completed the tasks associated with use case scenarios and provided comments recommendations on improving usability of MyPEEPS Mobile The mean of the overall Post Study System Usability Questionnaire scores rated by the end users was 1 63 SD 0 65 reflecting strong user acceptance of the app CONCLUSIONS The comments made by experts and end users will be used to refine MyPEEPS Mobile prior to a pilot study assessing the acceptability of the app across diverse sexual minority young men in their everyday lives
- ItemA Multi-Level Usability Evaluation of Mobile Health Applications: A Case Study.(0000-00-00) Cho, Hwayoung; Yen, Po-Yin; Dowding, Dawn; Merrill, Jacqueline; Schnall, RebeccaOBJECTIVE To report a methodological approach for the development of a usable mHealth application app MATERIALS AND METHODS This work was guided by a 3 level stratified view of health information technology IT usability evaluation framework We first describe a number of methodologies for operationalizing each level of the framework Following the description of each methodology we present a case study which illustrates the use of our preferred methodologies for the development of a mHealth app At level 1 user task we applied a card sorting technique to guide the information architecture of a mobile HIV symptom self management app entitled mVIP At level 2 user task system we conducted a usability evaluation of the mVIP in a laboratory setting through end user usability testing and heuristic evaluation with informatics experts At level 3 user task system environment usability of the mVIP was evaluated in a real world setting following the use of the app during a 3 month trial RESULTS The 3 level usability evaluation guided our work exploring in depth interactions between the user task system and environment Integral to the findings from the 3 level usability evaluation we iteratively refined the app s content functionality and interface to meet the needs of our intended end users DISCUSSION AND CONCLUSION The stratified view of the health IT usability evaluation framework is a useful methodological approach for the design development and evaluation of mHealth apps The methodological recommendations for using the theoretical framework can inform future usability studies of mHealth apps
- ItemA Multi-step Usability Evaluation of a Self-Management App to Support Medication Adherence in Persons Living with HIV.(0000-00-00) Beauchemin, Melissa; Gradilla, Melissa; Baik, Dawon; Cho, Hwayoung; Schnall, RebeccaPURPOSE Adherence to antiretroviral therapy is essential to HIV management and sustaining viral suppression Despite simplified regimens adherence remains difficult for certain persons living with HIV PLWH There is evidence to support the use of mHealth apps for effective self management in PLWH however a medication adherence app with real time monitoring for this population has not been developed and rigorously evaluated by PLWH We developed a mHealth app WiseApp for HIV self management to help PLWH self manage their health The purpose of this study was to evaluate the usability of the WiseApp METHODS We conducted a three step usability evaluation using 1 a traditional think aloud protocol with end users 2 a heuristic evaluation with experts in informatics and 3 a cognitive walkthrough with end users During the cognitive walkthrough we tested two devices fitness tracker and medication tracking bottle that were linked to the WiseApp RESULTS The think aloud protocol informed iterative updates to the app specifically to make it easier to see different sections of the app The heuristic evaluation confirmed the necessity of these design changes The cognitive walkthrough informed additional updates and confirmed that overall the app and the linked devices were usable for the end users CONCLUSION The results of the cognitive walkthrough with both experts and end users informed iterative refinements to the WiseApp and finalization of a mHealth app for PLWH to better self manage their health
- ItemNovel mHealth App to Deliver Geriatric Assessment-Driven Interventions for Older Adults With Cancer: Pilot Feasibility and Usability Study.(0000-00-00) Loh, Kah Poh; Ramsdale, Erika; Culakova, Eva; Mendler, Jason H; Liesveld, Jane L; O'Dwyer, Kristen M; McHugh, Colin; Gilles, Maxence; Lloyd, Terri; Goodman, Molly; Klepin, Heidi D; Mustian, Karen M; Schnall, Rebecca; Mohile, Supriya GBACKGROUND Older patients with cancer are at an increased risk of adverse outcomes A geriatric assessment GA is a compilation of reliable and validated tools to assess domains that are predictors of morbidity and mortality and it can be used to guide interventions However the implementation of GA and GA driven interventions is low due to resource and time limitations GA driven interventions delivered through a mobile app may support the complex needs of older patients with cancer and their caregivers OBJECTIVE We aimed to evaluate the feasibility and usability of a novel app TouchStream and to identify barriers to its use As an exploratory aim we gathered preliminary data on symptom burden health care utilization and satisfaction METHODS In a single site pilot study we included patients aged 65 years undergoing treatment for systemic cancer and their caregivers TouchStream consists of a mobile app and a Web portal Patients underwent a GA at baseline with the study team on paper and the results were used to guide interventions delivered through the app A tablet preloaded with the app was provided for use at home for 4 weeks Feasibility metrics included usability system usability scale of 68 is considered above average recruitment retention number of subjects consented who completed postintervention assessments and percentage of days subjects used the app For the last 8 patients we assessed their symptom burden severity and interference with 17 items scored from 0 10 where a higher score indicates worse symptoms using a clinical symptom inventory health care utilization from the electronic medical records and satisfaction 6 items scored on a 5 point Likert Scale for both patients and caregivers where a higher score indicates higher satisfaction using a modified satisfaction survey Barriers to use were elicited through interviews RESULTS A total of 18 patients mean age 76 8 range 68 87 and 13 caregivers mean age 69 8 range 38 81 completed the baseline assessment Recruitment and retention rates were 67 and 80 respectively The mean SUS score was 74 0 for patients and 72 2 for caregivers Mean percentage of days the TouchStream app was used was 78 7 Mean symptom severity and interference scores were 1 6 and 2 8 at preintervention and 0 9 and 1 5 at postintervention respectively There was a total of 27 clinic calls during the intervention period and 15 during the postintervention period week 5 8 One patient was hospitalized during the intervention period week 1 4 and two patients during the postintervention period week 5 8 Mean satisfaction scores of patients and caregivers with the mobile app were 20 4 and 23 4 respectively Barriers fell into 3 themes general experience design and functionality CONCLUSIONS TouchStream is feasible and usable for older patients on cancer treatment and their caregivers Future studies should evaluate the effects of the TouchStream on symptoms and health care utilization in a randomized fashion
- ItemPredictors of depression screening rates of nurses receiving a personal digital assistant-based reminder to screen.(2010-07-09) Schnall, Rebecca; Currie, Leanne M; Jia, Haomiao; John, Rita Marie; Lee, Nam-Ju; Velez, Olivia; Bakken, SuzanneThe purpose of this study was to determine if race ethnicity payer type or nursing specialty affected depression screening rates in primary care settings in which nurses received a reminder to screen The sample comprised 4 160 encounters in which nurses enrolled in advanced practice training were prompted to screen for depression using the Patient Health Questionnaire PHQ 2 PHQ 9 integrated into a personal digital assistant based clinical decision support system for depression screening and management Nurses chose to screen in response to 52 5 of reminders Adjusted odds ratios showed that payer type and nurse specialty but not race ethnicity significantly predicted proportion of patients screened
- ItemPsychometric evaluation of a handheld decision support attitudes scale.(2008-08-12) Schnall, Rebecca; Velez, Olivia; Dilone, Joann; Bakken, SuzanneThe authors evaluated the psychometrics of a 14 item scale designed to assess attitudes about handheld decision support software In a sample of 103 nursing students a principal components factor analysis resulted in three factors that explained 55 1 of the variance Internal consistency reliability ranged from 71 83
- ItemPsychometric evaluation of the attitudes toward Handheld Decision Support Software Scale in a sample of nursing students.(2011-04-22) Schnall, Rebecca; Velez, Olivia; John, Rita Marie; Bakken, SuzanneValid measures of attitudes are an important component of developing and testing educational interventions aimed at improving technology acceptance The aim of this study was to assess the construct validity factor analysis and discriminant validity internal consistency reliability Cronbach and responsiveness independent samples t test of the Attitudes toward Handheld Decision Support Software Scale in a sample of 103 nursing students engaged in a set of curricular activities focused on enabling safe and evidence based nursing practice through the use of information technology Principal components factor analysis resulted in three factors ease of use and usefulness clinical support and barriers to use that explained 55 49 of the variance Internal consistency reliability estimates ranged from 61 to 82 Factor scores did not discriminate between nursing students who owned a PDA and those who did not There were no significant changes in factors scores over time responsiveness This study provides preliminary evidence for the factorial structure of the Handheld Decision Support Software Scale and internal consistency of two of the three factor scales Further exploration of the construct validity internal consistency and responsiveness is warranted
- ItemUnderstanding the predisposing, enabling, and reinforcing factors influencing the use of a mobile-based HIV management app: A real-world usability evaluation.(0000-00-00) Cho, Hwayoung; Porras, Tiffany; Baik, Dawon; Beauchemin, Melissa; Schnall, RebeccaOBJECTIVE To conduct an in depth analysis of users experiences using an HIV self management app MATERIALS AND METHODS We conducted four follow up focus groups at the end of a 3 month randomized feasibility trial All focus group sessions were audio recorded and transcribed A thematic analysis was conducted to explore emerging themes All of the themes were categorized into three factors of the PRECEDE component of the PRECEDE PROCEED framework For a finer granularity of analysis the codes of each theme were broken into positive negative and neutral codes by study group RESULTS 36 participants including 24 from the intervention group and 12 from the control group participated in the focus group sessions A total of 14 themes organized by the PRECEDE factors were identified from focus group transcripts Five themes related to predisposing factors were 1 ease of app use 2 user friendly functionality 3 self efficacy for symptom management 4 design preference of illustrated strategies with videos and 5 user control convenience vs security Four themes related to enabling factors were 1 information needs of symptom management 2 symptom tracking 3 fit in lifestyle schedule living conditions and 4 additional languages e g Spanish Five themes related to reinforcing factors were 1 communication with healthcare providers 2 individual tailored information visualization 3 social networking 4 individual tailored information quality and 5 improvement in quality of life DISCUSSION AND CONCLUSION Usability evaluation in a real world setting enabled us to measure users actual experiences when interacting with the app during their everyday lives Our work highlights the importance of using mobile technology for persons living with HIV specifically those with low income housing instability and adds to the body of literature on the potential for implementation and dissemination of symptom self management strategies through a mobile platform
- ItemUsability Testing of a mHealth App to Support Self-Management of HIV-Associated Non-AIDS Related Symptoms.(0000-00-00) Stonbraker, Samantha; Cho, Hwayoung; Hermosi, Gabriella; Pichon, Adrienne; Schnall, RebeccaMobile health mHealth applications apps are uniquely poised to offer the information that persons living with HIV PLWH need to manage the symptoms associated with their chronic condition The purpose of this study was to assess the usability of a mHealth app designed to help PLWH self man age the symptoms associated with their HIV and HIV associated non AIDS HANA conditions We conducted a heuristic evaluation with five experts in informatics and end user testing with 20 PLWH End users completed the PSSUQ and Health ITUES validated measures of system usability Mean severity scores for the 10 item heuristic checklist com pleted by experts ranged from 0 4 2 4 End users gave the system high scores on the PSSUQ and Health ITUES usability measures mean 2 23 0 83 and 4 24 0 62 respectively Results indicated the system is usable and will be ready for future efficacy testing after incorporation of recommended feedback
- ItemUsing text messaging to assess adolescents' health information needs: an ecological momentary assessment.(2013-03-07) Schnall, Rebecca; Okoniewski, Anastasia; Tiase, Victoria; Low, Alexander; Rodriguez, Martha; Kaplan, StevenBACKGROUND Use of mobile technology has made a huge impact on communication access and information resource delivery to adolescents Mobile technology is frequently used by adolescents OBJECTIVE The purpose of this study was to understand the health information needs of adolescents in the context of their everyday lives and to assess how they meet their information needs METHODS We gave 60 adolescents smartphones with unlimited text messaging and data for 30 days Each smartphone had applications related to asthma obesity human immunodeficiency virus and diet preinstalled on the phone We sent text messages 3 times per week and asked the following questions 1 What questions did you have about your health today 2 Where did you look for an answer mobile device mobile application online friend book or parent 3 Was your question answered and how 4 Anything else RESULTS Our participants ranged from 13 18 years of age 37 62 participants were male and 22 37 were female Of the 60 participants 71 42 60 participants identified themselves as Hispanic and 77 46 60 were frequent users of mobile devices We had a 90 1935 2150 response rate to our text messages Participants sent a total of 1935 text messages in response to the ecological momentary assessment questions Adolescents sent a total of 421 text messages related to a health information needs and 516 text messages related to the source of information to the answers of their questions which were related to parents friends online mobile apps teachers or coaches CONCLUSIONS Text messaging technology is a useful tool for assessing adolescents health behavior in real time Adolescents are willing to use text messaging to report their health information Findings from this study contribute to the evidence base on addressing the health information needs of adolescents In particular attention should be paid to issues related to diet and exercise These findings may be the harbinger for future obesity prevention programs for adolescents