Consensus on the Terms and Procedures for Planning and Reporting a Usability Evaluation of Health-Related Digital Solutions: Delphi Study and a Resulting Checklist.

BACKGROUND: Usability evaluation both by experts and target users is an integral part of the process of developing and assessing digital solutions. Usability evaluation improves the probability of having digital solutions that are easier, safer, more efficient, and more pleasant to use. However, despite the widespread recognition of the importance of usability evaluation, there is a lack of research and consensus on related concepts and reporting standards. OBJECTIVE: The aim of the study is to generate consensus on terms and procedures that should be considered when planning and reporting a study on a usability evaluation of health-related digital solutions both by users and experts and provide a checklist that can easily be used by researchers when conducting their usability studies. METHODS: A Delphi study with 2 rounds was conducted with a panel of international participants experienced in usability evaluation. In the first round, they were asked to comment on definitions, rate the importance of preidentified methodological procedures using a 9-item Likert scale, and suggest additional procedures. In the second round, experienced participants were asked to reappraise the relevance of each procedure informed by round 1 results. Consensus on the relevance of each item was defined a priori when at least 70% or more experienced participants scored an item 7 to 9 and less than 15% of participants scored the same item 1 to 3. RESULTS: A total of 30 participants (n=20 females) from 11 different countries entered the Delphi study with a mean age of 37.2 (SD 7.7) years. Agreement was achieved on the definitions for all usability evaluation-related terms proposed (usability assessment moderator, participant, usability evaluation method, usability evaluation technique, tasks, usability evaluation environment, usability evaluator, and domain evaluator). A total of 38 procedures related to usability evaluation planning and reporting were identified across rounds (28 were related to usability evaluation involving users and 10 related to usability evaluation involving experts). Consensus on the relevance was achieved for 23 (82%) of the procedures related to usability evaluation involving users and for 7 (70%) of the usability evaluation procedures involving experts. A checklist was proposed that can guide authors when designing and reporting usability studies. CONCLUSIONS: This study proposes a set of terms and respective definitions as well as a checklist to guide the planning and reporting of usability evaluation studies, constituting an important step toward a more standardized approach in the field of usability evaluation that may contribute to enhancing the quality of planning and reporting usability studies. Future studies can contribute to further validating this study work by refining the definitions, assessing the practical applicability of the checklist, or assessing whether using this checklist results in higher-quality digital solutions.

A Mobile App to Support Clinical Diagnosis of Upper Respiratory Problems (eHealthResp): Co-Design Approach.

BACKGROUND: The misuse of antibiotics is a global public health issue that fosters bacterial resistance and jeopardizes generational health. The development of validated tools such as web-based courses and mobile apps to enhance clinical decisions in upper respiratory infections is of great importance in reducing the incorrect use of antibiotics in these situations. OBJECTIVE: The aim of this study was to design and prevalidate the interface of a mobile app to assist and provide clinical support in the diagnosis of upper respiratory problems. We aimed to assess the adequacy and usability of the interface of the tool in the belief that it could be beneficial to health care delivery in the clinical decision setting. METHODS: Using a co-design approach that brought together professionals in interface design and experts in pharmacology and pharmacoepidemiology, the mobile app interface was evaluated through peer review sessions held by interface design professionals on a heuristic survey. The reviewers accessed a high-fidelity interactive mock-up of the interface and filled in a questionnaire to assess the dimensions of layout and visual design and navigation and tasks. The resulting feedback of this evaluation supported the redesign of the primary interface, which was assessed for the second time by 2 of the previously mentioned reviewers. RESULTS: With 4 as the highest score, the interface scored a mean of 3.16 (SD 0.45; median of the means 3.2) for layout and visual design and a mean of 3.43 (SD 0.33; median of the means 3.51) for navigation and tasks, reflecting an overall positive evaluation. The open-ended commentaries allowed us to better understand specific recommendations of the reviewers. Throughout this section, approximately 0.98 comments per parameter were registered, reflecting a high level of effectiveness of the chosen parameters in identifying potential problems. The resultant beta version of the interface, addressing the majority of the detected problems, was further assessed by 2 of the previous reviewers, validating the new design. Future tests with physicians and pharmacists will help assess credibility and user experience dimensions. CONCLUSIONS: Our study revealed that the designed interface is easy to interpret and use. Peer reviewers raised important issues that could be easily fixed and positively reassessed. As a result, the study enabled us to produce a new tool for interface usability assessment and a set of recommendations for developing mobile interfaces for clinical decision support systems in the scope of upper respiratory problems.

Can Smartphones Promote Cancer Prevention Behaviours in Healthy Young Adults? A Prospective Study.

Cancer prevention should start as early as possible. Young adults would benefit largely from the use of a smartphone app aiming at promoting cancer prevention behaviours. The aims of the study described in this paper are to (1) examine the user participation and engagement with a cancer prevention app in real-life settings and (2) assess changes in the users' cancer prevention behaviours. A cancer prevention smartphone app called Happy was developed and released to the general population. Data from registered app users' (N = 3326) demographics and baseline cancer prevention behaviours was analysed. App engagement was measured and all behaviour data logged through the app was analysed to assess the effectiveness of the app in the promotion of cancer prevention behaviours. User demographics and baseline behaviour assessment show that the app reached its intended target population: young adults that generally do not comply with cancer prevention guidelines. Logged behavioural data showed an increased frequency in several cancer prevention behaviours and a significant increase in the overall putative cancer prevention level (p < 0.001). However, user engagement with the app was limited and might condition the long-term impact of such changes. Happy reached its intended population and seems to be an effective tool to promote cancer prevention. Further research is needed to fully assess its long-term persuasive potential.

Impact of a Digital Intervention for Literacy in Depression among Portuguese University Students: A Randomized Controlled Trial.

Digital interventions are important tools to promote mental health literacy among university students. "Depression in Portuguese University Students" (Depressão em Estudantes Universitários Portugueses, DEEP) is an audiovisual intervention describing how symptoms can be identified and what possible treatments can be applied. The aim of this study was to evaluate the impact of this intervention. A random sample of 98 students, aged 20-38 years old, participated in a 12-week study. Participants were recruited through social media by the academic services and institutional emails of two Portuguese universities. Participants were contacted and distributed into four study groups (G1, G2, G3 and G4): G1 received the DEEP intervention in audiovisual format; G2 was given the DEEP in text format; G3 received four news articles on depression; G4 was the control group. A questionnaire was shared to collect socio-demographic and depression knowledge data as a pre-intervention method; content was then distributed to each group following a set schedule; the depression knowledge questionnaire was then administered to compare pre-intervention, post-intervention and follow-up literacy levels. Using the Scheffé and Least Significant Difference (LSD) multiple comparisons test, it was found that G1, which received the DEEP audiovisual intervention, differed significantly from the other groups, with higher depression knowledge scores in post-intervention stages. The DEEP audiovisual intervention, compared to the other formats used (narrative text format; news format), proved to be an effective tool for increasing depression knowledge in university students.

Face masks on Instagram: an analysis of public health authorities' guidance toward prevention.

Instagram (IG) has been used as a health promotion tool by national and international sanitary authorities to tackle COVID-19. The profile of the World Health Organization (WHO) on IG contributed to spread and update information on the new coronavirus prevention This study focus attention on a non-pharmaceutical control measure (face mask in the community) and discusses the adaptation of health authorities from Portugal and Brazil to WHO guidelines on this topic, and how they passed them to citizens. A content analysis of posts from WHO, Portuguese National Health Service (NHS), and the Brazilian Ministry of Health (MH) profiles on IG was carried out, in the first 100 days of the pandemic. The sample is composed of 65 posts - WHO (12), NHS (36) and, MH (17). NHS highlights masks in 8,8% of posts and MH in 3,3%. WHO guidelines followed scientific evidence and prioritized the surgical masks, while NHS and MH adapted the guidelines to regional scenarios (community transmission and difficulty to social distancing) and produced information on non-surgical masks. NHS recommends the use of certified non-surgical masks. MH diverged from WHO guidelines and advised cloth masks. NHS has adopted the preventive approach and the use of celebrities to stress the importance of following its guidelines. MH adopted an institutional approach to encourage adherence to the instructions. Both profiles offered incomplete content on the production, use, disposal, and maintenance of masks.

A roadmap for the development and evaluation of the eHealthResp online course.

Background: Inappropriate antibiotic use constitutes one of the most concerning public health issues, being one of the main causes of antibiotic resistance. Hence, to tackle this issue, it is important to encourage the development of educational interventions for health practitioners, namely by using digital health tools. This study focuses on the description of the development and validation process of the eHealthResp online course, a web platform directed to physicians and pharmacists, with the overall goal of improving antibiotic use for respiratory tract infections, along with the assessment of its usability. Methods: The eHealthResp platform and the courses, developed with a user-centered design and based on Wordpress and MySQL, were based on a previously developed online course. A questionnaire to assess the usability was distributed among physicians (n = 6) and pharmacists (n = 6). Based on the obtained results, statistical analyses were conducted to calculate the usability score and appraise the design of the online course, as well as to compare the overall scores attributed by both groups. Further qualitative comments provided by the participants have also been analyzed. Results: The eHealthResp contains two online courses directed to physicians and pharmacists aiming to aid in the management of respiratory tract infections. The average usability score of the eHealthResp online courses for physicians and pharmacists was of 78.33 (±11.57, 95%CI), and 83.75 (±15.90, 95%CI), respectively. Qualitative feedback emphasized the usefulness of the course, including overall positive reviews regarding user-friendliness and consistency. Conclusions: This study led us to conclude that the eHealthResp online course is not recognized as a complex web platform, as both qualitative and quantitative feedback obtained were globally positive.

Perceptions on Extending the Use of Technology after the COVID-19 Pandemic Resolves: A Qualitative Study with Older Adults.

The COVID-19 pandemic of the last two years has affected the lives of many individuals, especially the most vulnerable and at-risk population groups, e.g., older adults. While social distancing and isolation are shown to be effective at decreasing the transmission of the virus, these actions have also increased loneliness and social isolation. To combat social distancing from family and friends, older adults have turned to technology for help. In the health sector, these individuals also had a variety of options that strengthened eHealth care services. This study analyzed the technologies used during the COVID-19 pandemic by a group of older people, as well as explored their expectations of use after the pandemic period. Qualitative and ethnographic interviews were conducted with 10 Portuguese older adults, and data were collected over a period of seven months between 2020 and 2021. The research demonstrated that the use of current and new technologies in the post-pandemic future is likely to be related to overcoming: (i) insecurity regarding privacy issues; (ii) difficulties in using technologies due to the level of use of digital technology; and (iii) the human distancing and impersonal consequences of using these technologies.

Procedures of User-Centered Usability Assessment for Digital Solutions: Scoping Review of Reviews Reporting on Digital Solutions Relevant for Older Adults.

BACKGROUND: The assessment of usability is a complex process that involves several steps and procedures. It is important to standardize the evaluation and reporting of usability procedures across studies to guide researchers, facilitate comparisons across studies, and promote high-quality usability studies. The first step to standardizing is to have an overview of how usability study procedures are reported across the literature. OBJECTIVE: This scoping review of reviews aims to synthesize the procedures reported for the different steps of the process of conducting a user-centered usability assessment of digital solutions relevant for older adults and to identify potential gaps in the present reporting of procedures. The secondary aim is to identify any principles or frameworks guiding this assessment in view of a standardized approach. METHODS: This is a scoping review of reviews. A 5-stage scoping review methodology was used to identify and describe relevant literature published between 2009 and 2020 as follows: identify the research question, identify relevant studies, select studies for review, chart data from selected literature, and summarize and report results. The research was conducted on 5 electronic databases: PubMed, ACM Digital Library, IEEE, Scopus, and Web of Science. Reviews that met the inclusion criteria (reporting on user-centered usability evaluation procedures for any digital solution that could be relevant for older adults and were published in English) were identified, and data were extracted for further analysis regarding study evaluators, study participants, methods and techniques, tasks, and test environment. RESULTS: A total of 3958 articles were identified. After a detailed screening, 20 reviews matched the eligibility criteria. The characteristics of the study evaluators and participants and task procedures were only briefly and differently reported. The methods and techniques used for the assessment of usability are the topics that were most commonly and comprehensively reported in the reviews, whereas the test environment was seldom and poorly characterized. CONCLUSIONS: A lack of a detailed description of several steps of the process of assessing usability and no evidence on good practices of performing it suggests that there is a need for a consensus framework on the assessment of user-centered usability evaluation. Such a consensus would inform researchers and allow standardization of procedures, which are likely to result in improved study quality and reporting, increased sensitivity of the usability assessment, and improved comparability across studies and digital solutions. Our findings also highlight the need to investigate whether different ways of assessing usability are more sensitive than others. These findings need to be considered in light of review limitations.

The Performance of Minicircle DNA Versus Parental Plasmid in p53 Gene Delivery Into HPV-18-Infected Cervical Cancer Cells.

Minicircle DNA (mcDNA) has been suggested as a vanguard technology for gene therapy, consisting of a nonviral DNA vector devoid of prokaryotic sequences. Unlike conventional plasmid DNA (pDNA), this small vector is able to sustain high expression rates throughout time. Thus, this work describes the construction, production, and purification of mcDNA-p53 and its precursor parental plasmid (PP)-p53 for a comparative study of both DNA vectors in the growth suppression of human papillomavirus (HPV)-18-infected cervical cancer cells. First, live cell imaging and fluorescence microscopy studies allowed to understand that mcDNA-p53 vector was able to enter cell nuclei more rapidly than PP-p53 vector, leading to a transfection efficiency of 68% against 34%, respectively. Then, p53 transcripts and protein expression assessment revealed that both vectors were able to induce transcription and the target protein expression. However, the mcDNA-p53 vector performance stood out, by demonstrating higher p53 expression levels (91.65 ± 2.82 U/mL vs. 74.75 ± 4.44 U/mL). After assuring the safety of both vectors by viability studies, such potential was confirmed by proliferation and apoptosis assays. These studies confirmed the mcDNA-p53 vector function toward cell cycle arrest and apoptosis in HPV-18-infected cervical cancer cells. Altogether, these results suggest that the mcDNA vector has a more promising and efficient role as a DNA vector than conventional pDNA, opening new investigation lines for cervical cancer treatment in the future.

Are you ready for the challenge? Social Media Health Challenges for Behaviour Change.

Challenges are one of the most common strategies used by Opinion Leaders on Social Media to engage users. They are often found in different areas; in the Health field, the use of challenges is growing, namely through initiatives aiming at eating behaviour change. Instagram is considered to be one of the most used Social Media applications to develop these initiatives, allowing Opinion Leaders to communicate and engage with their online followers. Despite this scenario, little is known regarding how Health Challenges are being used and what is their impact on behaviour change. Previous research has already shown how Opinion Leaders use Instagram to promote eating behaviour change. The purpose of this paper is to conceptualize, describe and discuss Social Media Health Challenges, aiming to analyse Instagram challenges on healthy eating. The study was organized in two phases: the first one is a literature review based on Prisma method that supported the conceptualisation of Social Media Challenges and the design for the second phase where Social Media Health Challenges of Opinion Leaders, such as Nutritionists, Health Lifestylers and Patient Opinion Leaders (POLS) were analysed. Results showed that most of the challenges are promoted by Patient Opinion Leaders and Health Lifestylers. Followers adhere to Social Media Health Challenges related to weight loss, engaging with Opinion Leaders. The psychological-cognitive components (such as habits, motivation, and self-control) were found in the analysed challenges, and Instagram is one of the used tools to promote these Initiatives. These results point to new paths regarding future research on other behaviour change online initiatives.

Minicircle DNA: The Future for DNA-Based Vectors?

Minicircle DNA (mcDNA) is a smaller and safer version of non-viral DNA vectors that results from a cutting-edge in vivo recombination process to excise prokaryotic sequences from plasmid DNA (pDNA). Considering the molecule's potential and increasing interest as a non-viral DNA-based therapeutic, biomanufacturing methodologies need to be improved, especially in downstream processing.

Development of an online digital resource accessible for students with visual impairment or blindness: Challenges and strategies.

BACKGROUND: People with visual impairment or blindness face a wide range of daily barriers, both at school and at work. OBJECTIVE: This article describes the development process of an online resource, addressing Occupational Safety and Health (OSH), accessible for students with visual impairment or blindness. METHODS: This study was framed in a Design-Based Research methodology involving the analysis, design, development and implementation of a digital resource. In the analysis stage, a first list of accessibility challenges was created allowing the design of strategies and specific technical solutions to approach them. RESULTS: The development process has shown that online digital resources can be accessible for users with visual impairment or blindness and even the most visual contents and activities (based on images and videos) can be easily adjusted. CONCLUSIONS: Online accessible resources should be based on the World Wide Web Consortium (W3C) guidelines, allowing the proper description of all contents by screen readers, using audio description, accessible features and providing keyboard navigation. Further research must be conducted to deepen knowledge on the role of educational digital resources for students with visual impairment or blindness, namely regarding OSH barriers that workers with visual impairment or blindness face at the workplace (as visual safety signs and pictogram labels).

Pilot study of a smartphone-based intervention to promote cancer prevention behaviours.

BACKGROUND: Estimates predict that more than half of all cancers are due to inadequate lifestyle choices. Smartphones can be successfully used to support the behaviour change needed to prevent cancer. OBJECTIVE: The purpose of this study was to field-test Happy, a smartphone app designed to promote cancer prevention behaviours, based on tailored-messages. METHODS: Thirty-two participants downloaded and used the app for 28 consecutive days (4 weeks). At the end of this period, they all answered an online questionnaire and ten of them were interviewed. Usability, feasibility, message receptivity, and perceived impact of the app were assessed. RESULTS: Compliance with cancer prevention guidelines was lower than expected. Happy was considered simple, intuitive and easy to use. Messages sent by the app were considered easy to understand, providing good advice and meaningful information that catch reader's attention. Participants also considered that Happy might be an effective way to promote cancer prevention. Collected data showed an increased frequency in several cancer prevention related behaviours and an increase in the overall putative cancer prevention level. CONCLUSIONS: This study showed the viability of designing and implementing smartphone-based interventions to promote cancer prevention behaviours. The results suggest that Happy is usable and might help users change their behaviour towards healthier choices and thus reduce their personal cancer risk.

Guidelines for a cancer prevention smartphone application: A mixed-methods study.

OBJECTIVES: This study sought to explore the views and experiences of healthy young adults concerning the fundamental features of a cancer prevention smartphone app that seeks behaviour change. METHODS: Three focus groups were conducted with 16 healthy young adults that explored prior experiences, points of view and opinions about currently available health-related smartphone apps. Then, an online questionnaire was designed and applied to a larger sample of healthy young adults. Focus group and online questionnaire data were analysed and confronted. RESULTS: Study results identified behaviour tracking, goal setting, tailored information and use of reminders as the most desired features in a cancer prevention app. Participants highlighted the importance of privacy and were reluctant to share personal health information with other users. The results also point out important dimensions to be considered for long-term use of health promotion apps related with usability and perceived usefulness. Participants didn't consider gamification features as important dimensions for long-term use of apps. CONCLUSIONS: This study allowed the definition of a guideline set for the development of a cancer prevention app.

Brief Report: Preliminary Proposal of a Conceptual Model of a Digital Environment for Developing Mathematical Reasoning in Students with Autism Spectrum Disorders.

There is clear evidence that in typically developing children reasoning and sense-making are essential in all mathematical learning and understanding processes. In children with autism spectrum disorders (ASD), however, these become much more significant, considering their importance to successful independent living. This paper presents a preliminary proposal of a digital environment, specifically targeted to promote the development of mathematical reasoning in students with ASD. Given the diversity of ASD, the prototyping of this environment requires the study of dynamic adaptation processes and the development of activities adjusted to each user's profile. We present the results obtained during the first phase of this ongoing research, describing a conceptual model of the proposed digital environment. Guidelines for future research are also discussed.

A influência da web na tomada de decisão da grávida: rastreio pré-natal e tipo de parto / The influence of the web in the decision process of the pregnant woman: prenatal screening and type of birth

Este artigo explora a influência que a web tem nos mecanismos de tomada de decisão da grávida, por meio, apenas, da análise dos resultados obtidos pela participação de grávidas e relativamente às opções de "rastreio pré-natal" e de "tipo de parto". Em termos metodológicos, o estudo baseou-se nos dados recolhidos através de um survey exploratório, com base num inquérito por questionário, em suporte papel, aplicado a grávidas portuguesas. Apesar da importância da pesquisa na internet, é o contacto presencial, sobretudo com o médico, que mais as influencia. Concluiu-se que a revisão da literatura recente e a investigação sobre a utilização da internet por grávidas aponta que, no seu processo de tomada de decisão, a influência da opinião do médico é maior do quea das pesquisas digitais feitas por elas. Os resultados desse survey deverão ser úteis para pressionar os policy-makers a encontrar respostas eficazes e eficientes nesta matéria.

A influência da web na tomada de decisão da grávida: rastreio pré-natal e tipo de parto / The influence of the web in the decision process of the pregnant woman: prenatal screening and type of birth / La influencia de la web en la toma de decisiones de la mujer embarazada: detección prenatal y tipo de parto

Este artigo explora a influência que a web tem nos mecanismos de tomada de decisão da grávida, por meio, apenas, da análise dos resultados obtidos pela participação de grávidas e relativamente às opções de“rastreio pré-natal” e de “tipo de parto”. Em termos metodológicos, o estudo baseou-se nos dados recolhidos através de um survey exploratório, com base num inquérito por questionário, em suporte papel, aplicado a grávidas portuguesas. Apesar da importância da pesquisa na internet, é o contacto presencial, sobretudo com o médico, que mais as influencia. Concluiu-se que a revisão da literatura recente e a investigação sobre a utilização da internet por grávidas aponta que, no seu processo de tomada de decisão, a influênciada opinião do médico é maior do que a das pesquisas digitais feitas por elas. Os resultados desse survey deverão ser úteis para pressionar os policy-makers a encontrar respostas eficazes e eficientes nesta matéria...

This article explores the answers given by pregnant women concerning the options “prenatal screening”and “type of delivery”. The influence of the web on the decision-making processes of pregnant womenis analysed, aiming to understand how search practices, peer influence and opinion sharing are carriedout on the web. The results are based on data collected through an exploratory survey conducted with aquestionnaire applied to 178 Portuguese pregnant women. Although research on the internet has greateffect on the respondents, face to face contact is what most influences them, especially with the doctor.Relatives and friends are also relevant. The study pointed to the biggest influence of the doctor’s opinionover the internet in their decision-making process. These results should be useful for pressuring policymakersto find prompter and better quality answers...

El presente artículo analiza la influencia que la web tiene en la toma de decisiones de una mujer embarazada,con objectivo de entender la búsqueda de casos de “detección prenatal” y “tipo de parto” en páginas web, así como el papel de las influencias sociales y opiniones compartidas online. Los resultados están basados en la información recopilada en un estudio que se ha realizado a través de un cuestionario que ha sido llevado a cabo a mujeres portuguesas embarazadas. Los resultados demuestran que si bien la búsqueda en internet tiene un gran impacto, el contacto cara a cara, especialmente con un médico, es lo que tiene una mayor influencia. La opinión de los médicos en la toma de decisiones relacionadas con lo embarazo causa mayor influencia que las consultas efectuadas a través de internet. Los resultados deberían servir para ejercer presión en los que lideran estlas políticas de salud, para que encuentren respuestas más precisas y de mejor calidad...