User Experience Evaluation in Shared Interactive Virtual Reality.

Virtual reality (VR) has served the entertainment industry all the way to world-leading museums in delivering engaging experiences through multisensory virtual environments (VEs). Today, the rise of the Metaverse fuels a growing interest in leveraging this technology, bringing along an emerging need to better understand the way different dimensions of VEs, namely social and interactive, impact overall user experience (UX). This between-subject exploratory field study investigates differences in the perceived and lived experience of 28 participants engaging, either individually or in dyads, in a VR experience comprising different levels of interactivity, i.e., passive or active. A mixed methods approach combining conventional UX measures, i.e., psychometric surveys and user interviews, as well as psychophysiological measures, i.e., wearable bio- and motion sensors, allowed for a comprehensive assessment of users' immersive and affective experiences. Results pertaining to the social dimension of the experience reveal that shared VR elicits significantly more positive affect, whereas presence, immersion, flow, and state anxiety are unaffected by the copresence of a real-world partner. Results pertaining to the interactive dimension of the experience suggest that the interactivity afforded by the VE moderates the effect of copresence on users' adaptive immersion and arousal. These results support that VR can be shared with a real-world partner not only without hindering the immersive experience, but also by enhancing positive affect. Hence, in addition to offering methodological directions for future VR field research, this study provides interesting practical insights into guiding VR developers toward optimal multiuser virtual environments.

Facilitating engagement of universal school-based digital mental health solutions through user experience: A qualitative exploration.

Digital mental health intervention (DMHI) programs offered in schools present a readily-accessible and flexible means for educating, empowering, and supporting adolescents in maintaining a balanced mental health, especially during uncertain and stressful times such as the COVID-19 pandemic. Recent studies indicate that the effectiveness of DMHI programs in improving students' mental well-being and in preventing from their mental health complications depends on the users' engagement. This study focuses on identifying the user experience factors that can facilitate user engagement with universal school-based DMHI programs (i.e., the DMHI programs delivered to the students regardless of their mental health risks or conditions). To identify said factors, we sought to gain a deeper understanding of perceptions, opinions, and preferences of actual end-users (i.e., the adolescents) regarding their experiences with both digital and non-digital mental health resources. Specifically, interviews were conducted with two participant groups to uncover the reasons that could lead the adolescents to better engage with school-based DMHI programs, as well as the shortcomings that could prevent that from happening: (a) adolescent users who had either a high or a low level of engagement with universal DMHI programs of a specific school-based digital mental health solution; and (b) adolescents who had voluntarily used non-digital or non-school-based digital mental health resources for purposes other than treatment. Through a thematic analysis of interview data, the most important (or primary) and the additionally desirable (or secondary) factors that could lead to a higher engagement level for school-based DMHI programs were identified. Lastly, using the evidence gathered from our interviews, specific recommendations are proposed that could help in targeting each identified engagement factor and in increasing the likelihood that school-based DMHI programs achieve their desired outcome for high school students.

Effect of transitional care stroke case management interventions on caregiver outcomes: the MISTT randomized trial.

This study reports on outcomes for 169 caregivers enrolled in the Michigan Stroke Transitions Trial (MISTT), an RCT of social work case management for stroke patients returning home. A mixed-model approach examined the mean change from 7- to 90-days post-discharge with group-by-time interactions for differences between treatment groups. Caregivers reported few life changes or depressive symptoms from caregiving. There was no significant change over time or treatment effects. Negative aspects of stroke caregiving may take longer to develop. Focused caregiver assessment at discharge and a better understanding of how caregiving develops over time may improve the type and timing of support.

Michigan Stroke Transitions Trial.

BACKGROUND: To test whether access to home-based social worker-led case management (SWCM) program or SWCM program combined with a website providing stroke-related information improves patient-reported outcomes in patients with stroke, relative to usual care. METHODS AND RESULTS: The MISTT (Michigan Stroke Transitions Trial), an open (unblinded) 3-group parallel-design clinical trial, randomized 265 acute patients with stroke to 3 treatment groups: Usual Care (group-1), SWCM (group-2), and SWCM+MISTT website (group-3). Patients were discharged directly home or returned home within 4 weeks of discharge to a rehabilitation facility. The SWCM program provided in-home and phone-based case management services. The website provided patient-orientated information covering stroke education, prevention, recovery, and community resources. Both interventions were provided for up to 90 days. Outcomes data were collected by telephone at 7 and 90 days. Primary patient-reported outcomes included Patient-Reported Outcomes Measurement Information System Global-10 Quality-of-Life (Physical and Mental Health subscales) and the Patient Activation Measure. Treatment efficacy was determined by comparing the change in mean response (90 days minus 7 days) between the 3 treatment groups using a group-by-time interaction. Subjects were aged 66 years on average, 49% were female, 21% nonwhite, and 86% had ischemic stroke. There were statistically significant changes in Patient-Reported Outcomes Measurement Information System Physical Health ( P=0.003) and Patient Activation Measure ( P=0.042), but not Patient-Reported Outcomes Measurement Information System Mental Health ( P=0.56). The mean change in Patient-Reported Outcomes Measurement Information System Physical Health scores for group-3 (SWCM+MISTT Website) was significantly higher than both group-2 (SWCM; difference, +2.4; 95% CI, 0.46-4.34; P=0.02) and group-1 (usual care; difference, +3.4; 95% CI, 1.41-5.33; P<0.001). The mean change in Patient Activation Measure scores for group-3 was significantly higher than group-2 (+6.7; 95% CI, 1.26-12.08; P=0.02) and marginally higher than group-1 (+5.0; 95% CI, -0.47 to 10.52; P=0.07). CONCLUSIONS: An intervention that combined SWCM with access to online stroke-related information produced greater gains in patient-reported physical health and activation compared with usual care or case management alone. There was no intervention effect on mental health. CLINICAL TRIAL REGISTRATION: URL: https://www.clinicaltrials.gov . Unique identifier: NCT02653170.

Improving transitions in acute stroke patients discharged to home: the Michigan stroke transitions trial (MISTT) protocol.

BACKGROUND: For some stroke patients and caregivers, navigating the transition between hospital discharge and returning home is associated with substantial psychosocial and health-related challenges. Currently, no evidence-based standard of care exists that addresses the concerns of stroke patients and caregivers during the transition period. Objectives of the Michigan Stroke Transitions Trial (MISTT) are to test the impact of a social worker home-based case management program, as well as an online information and support resource, on patient and caregiver outcomes after returning home. METHODS: The Michigan Stroke Transitions Trial is a randomized, pragmatic, open (un-blinded), 3-group parallel designed superiority trial conducted in 3 Michigan hospitals. Eligible participants are adult acute stroke patients discharged home directly or within 4 weeks of being discharged to a rehabilitation facility. The patient's primary caregiver is also invited to participate. Patients are randomized on the day they return home using a randomized block design. Consented patients discharged to a rehabilitation facility who do not go home within 4 weeks are dropped from the study. The 2 study interventions begin within a week of returning home and conclude 3 months later. The 3-group design compares usual care to either a home-based social worker stroke case management (SWSCM) program, or a combination of the SWSCM program plus access to an online information and support resource (MISTT website). Outcomes data are collected at 7-days and 90-days by trained telephone interviewers. Primary patient outcomes include the PROMIS global 10 score (a generic Quality of Life scale), and the Patient Activation Measure (PAM). Caregiver outcomes include the Bakas Caregiving Outcomes Scale. Final analysis will be based on 214 randomized acute stroke patients. To accommodate subjects excluded due to prolonged rehabilitation stays, as well as those lost-to-follow-up, up to 315 patients will be consented. DISCUSSION: The MISTT study will determine if a home-based case management program designed around the needs and preferences of stroke patients and caregivers, alone or in combination with a patient-centered online information and support resource can improve stroke survivor and caregiver outcomes 3 months after returning home. TRIAL REGISTRATION: ClinicalTrials.gov: NCT02653170 (Protocol ID: 135457). Registered April 9, 2015.

Adult Cancer Patient Recruitment and Enrollment into Cell Phone Text Message Trials.

INTRODUCTION: Text messaging (TMs) on cell phones is emerging as an effective means of delivering behavioral interventions. However, little is known about TM use in adult cancer patients. The present study aimed to extend knowledge on acceptability of a TM intervention in adult cancer patients; examine factors of those screened and enrolled; and compare recruitment at a large national specialty pharmacy versus community-based cancer clinics. MATERIALS AND METHODS: Screening, enrollment, and baseline data collected in two randomized controlled trials examining the efficacy of TMs on medication adherence or symptom severity in adults prescribed oral anticancer agents were linked. Chi-square, Fisher's exact, t-tests, and generalized linear modeling were used to examine sociodemographics, cancer type and stage, depressive symptoms, self-efficacy, social support, and symptoms. RESULTS: The cancer clinics screened 293 patients, 43% were eligible, and 56% consented. The specialty pharmacy screened 169 patients, 72% were eligible, and 74% consented. Mean age was 58 years and did not differ by recruitment setting. Later stage disease (p = 0.01) and higher number of symptoms (p < 0.01), and symptom severity (p = 0.02) and interference (p = 0.01) were observed among patients recruited at the specialty pharmacy. No group differences were found for depression, physical function, cognition, self-efficacy, or social support. DISCUSSION: Adult cancer patients were likely to participate in a TM intervention trial. Recruiting through the specialty pharmacy reached a population with higher cell phone ownership and TM usage; with greater interest in a TM intervention compared to the cancer clinics.

Proof of Concept of a Mobile Health Short Message Service Text Message Intervention That Promotes Adherence to Oral Anticancer Agent Medications: A Randomized Controlled Trial.

INTRODUCTION: This multisite, randomized controlled trial assigned 75 adult cancer patients prescribed an oral anticancer agent to either an experimental group that received daily text messages for adherence for 21 days plus usual care or a control group that received usual care. MATERIALS AND METHODS: Measures were administered at baseline, weekly (Weeks 1-8), and at exit (Week 9). A satisfaction survey was conducted following the intervention. Acceptability, feasibility, and satisfaction were examined. Primary outcomes were adherence and symptoms. Secondary outcomes were depressive symptoms, self-efficacy, cognition, physical function, and social support. Mixed or general linear models were used for the analyses comparing trial groups. Effect sizes (ES) were estimated to gauge clinical significance. RESULTS: Regarding acceptability, 57.2% (83 of 145) of eligible patients consented, 88% (n = 37 of 42) receiving text messages read them most or all of the time, and 90% (n = 38) were satisfied. The differences between experimental and control groups' ES were 0.29 for adherence, 0.21 for symptom severity, and 0.21 for symptom interference, and differences were not statistically significant. Furthermore, perceived social support was higher (p = 0.04; ES = 0.54) in the experimental group. CONCLUSIONS: Proof of concept and preliminary efficacy of a mobile health intervention using text messages to promote adherence for patients prescribed oral anticancer agents were demonstrated. Patients accepted and had high satisfaction with the intervention, and adherence improved after the intervention. Text messages show promise. Additional research is needed prior to use in practice.

Feasibility of a Text Messaging Intervention to Promote Self-Management for Patients Prescribed Oral Anticancer Agents.

PURPOSE/OBJECTIVES: To determine proof of concept of a mobile health (mHealth) intervention delivering text messages (texts) to self-manage among patients prescribed oral anticancer agents (OAs) and to examine preliminary efficacy on symptoms and medication adherence. DESIGN: A longitudinal randomized, controlled trial. SETTING: Two community cancer centers in the midwestern United States and a national specialty pharmacy. SAMPLE: 80 adults with cancer who were newly prescribed OAs
. METHODS: Adherence and symptoms were assessed weekly for 10 weeks in both groups. The intervention group received daily texts for adherence and weekly for symptoms for 21-28 days, and satisfaction with the intervention was assessed
. MAIN RESEARCH VARIABLES: Medication adherence and symptom severity. FINDINGS: Mean age was 58.5 years (SD = 10.7 years), 48 participants were female, and 48 were Caucasian. Fewer symptoms were found in the intervention group with a moderate effect size. Adherence was higher in the text group using medical record and prescription data (n = 26) with greater relative dose intensity of moderate to large effect size. Regarding acceptability, 57% (83 of 145) of eligible participants consented, 39 of 40 participants completed the entire intervention, 30 participants read texts all of the time, and 34 participants were satisfied with the intervention.
 CONCLUSIONS: Proof of concept and preliminary efficacy of an mHealth intervention using texts to promote self-management for patients prescribed OAs was demonstrated. Patients had high satisfaction with the texts, and adherence and symptoms improved after the intervention. IMPLICATIONS FOR NURSING: Texts show promise for patients with cancer who must manage their OAs. Additional research is needed prior to use in practice.

A randomized controlled trial of the feasibility and preliminary efficacy of a texting intervention on medication adherence in adults prescribed oral anti-cancer agents: study protocol.

AIM: The aim of this study was to report a study protocol that examines feasibility, preliminary efficacy and satisfaction of a text message intervention on the outcome of medication adherence in adult patients prescribed oral anti-cancer agents. BACKGROUND: Administration of oral anti-cancer agents occurs in the home setting, requiring patients to self-manage the regimen as prescribed. However, many barriers to medication adherence exist: regimens are often complex, with cycling of two or more medications; side effects of treatment; most cancer patients are older with comorbid conditions and competing demands; and cognitive decline and forgetfulness may occur. Research indicates patients miss nearly one-third of the prescribed oral anti-cancer agent dosages. Text message interventions have been shown to improve medication adherence in chronic conditions other than cancer. However, a majority of those patients were less than 50 years of age and most cancer patients are diagnosed later in life. DESIGN: A two-group randomized controlled trial with repeated measures. METHODS: Seventy-five adult patients newly prescribed an oral anti-cancer agent will be recruited (project funded in April 2013) from community cancer centres and a specialty pharmacy. Participants will be randomized to either a control group (n = 25; usual care) or an intervention group (n = 50; usual care plus text messages timed to medication regimen). Outcome measures include: medication adherence, feasibility and satisfaction with the intervention. Data will be collected over 8 weeks: baseline, weekly and exit. DISCUSSION: Standardized text message intervention protocol and detailed study procedures have been developed in this study to improve medication adherence.