Assessing the Usability and Feasibility of Digital Assistant Tools for Direct Support Professionals: Participatory Design and Pilot-Testing.

BACKGROUND: The United States is experiencing a direct support professional (DSP) crisis, with demand far exceeding supply. Although generating documentation is a critical responsibility, it is one of the most wearisome aspects of DSPs' jobs. Technology that enables DSPs to log informal time-stamped notes throughout their shift could help reduce the burden of end-of-shift documentation and increase job satisfaction, which in turn could improve the quality of life of the individuals with intellectual and developmental disabilities (IDDs) whom DSPs support. However, DSPs, with varied ages, levels of education, and comfort using technology, are not likely to adopt tools that detract from caregiving responsibilities or increase workload; therefore, technological tools for them must be relatively simple, extremely intuitive, and provide highly valued capabilities. OBJECTIVE: This paper describes the development and pilot-testing of a digital assistant tool (DAT) that enables DSPs to create informal notes throughout their shifts and use these notes to facilitate end-of-shift documentation. The purpose of the pilot study was to assess the usability and feasibility of the DAT. METHODS: The research team applied an established user-centered participatory design process to design, develop, and test the DAT prototypes between May 2020 and April 2023. Pilot-testing entailed having 14 DSPs who support adults with IDDs use the first full implementation of the DAT prototypes during 2 or 3 successive work shifts and fill out demographic and usability questionnaires. RESULTS: Participants used the DAT prototypes to create notes and help generate end-of-shift reports. The System Usability Scale score of 81.79 indicates that they found the prototypes easy to use. Survey responses imply that using the DAT made it easier for participants to produce required documentation and suggest that they would adopt the DAT if this tool were available for daily use. CONCLUSIONS: Simple technologies such as the DAT prototypes, which enable DSPs to use mobile devices to log time-stamped notes throughout their shift with minimal effort and use the notes to help write reports, have the potential to both reduce the burden associated with producing documentation and enhance the quality (level of detail and accuracy) of this documentation. This could help to increase job satisfaction and reduce turnover in DSPs, both of which would help improve the quality of life of the individuals with IDDs whom they support. The pilot test results indicate that DSPs found the DAT easy to use. Next steps include (1) producing more robust versions of the DAT with additional capabilities, such as storing data locally on mobile devices when Wi-Fi is not available; and (2) eliciting input from agency directors, families, and others who use data about adults with IDDs to help care for them to ensure that data produced by DSPs are relevant and useful.

Direct Support Professionals' Perspectives on Using Technology to Help Support Adults With Autism Spectrum Disorder: Mixed Methods Study.

BACKGROUND: Documentation is a critical responsibility for direct support professionals (DSPs) who work with adults with autism spectrum disorder (ASD); however, it contributes significantly to their workload. Targeted efforts must be made to mitigate the burden of necessary data collection and documentation, which contributes to high DSP turnover rates and poor job satisfaction. OBJECTIVE: This mixed methods study aimed to explore how technology could assist DSPs who work with adults with ASD and prioritize aspects of technology that would be most useful for future development efforts. METHODS: In the first study, 15 DSPs who worked with adults with ASD participated in 1 of the 3 online focus groups. The topics included daily tasks, factors that would influence the adoption of technology, and how DSPs would like to interact with technologies to provide information about their clients. Responses were thematically analyzed across focus groups and ranked by salience. In the second study, 153 DSPs across the United States rated the usefulness of technology features and data entry methods and provided qualitative responses on their concerns regarding the use of technology for data collection and documentation. Quantitative responses were ranked based on their usefulness across participants, and rank-order correlations were calculated between different work settings and age groups. The qualitative responses were thematically analyzed. RESULTS: In study 1, participants described difficulties with paper-and-pencil data collection, noted benefits and concerns about using technology instead, identified benefits and concerns about particular technology features, and specified work-environment factors that impact data collection. In study 2, participants rated multiple features of technology as useful, with the highest usefulness percentages endorsed for task views (ie, by shift, client, and DSP), logging completed tasks, and setting reminders for specific tasks. Participants also rated most data entry methods (eg, typing on a phone or tablet, typing on a keyboard, and choosing from options on a touch screen) as useful. Rank-order correlations indicated that the usefulness of technology features and data entry methods differed across work settings and age groups. Across both studies, DSPs cited some concerns with technology, such as confidentiality, reliability and accuracy, complexity and efficiency, and data loss from technology failure. CONCLUSIONS: Understanding the challenges faced by DSPs who work with adults with ASD, and their thoughts about using technology to meet those challenges, represents an essential first step toward developing technology solutions that can increase DSPs' effectiveness and job satisfaction. The survey results indicate that technology innovations should incorporate multiple features to account for different needs across DSPs, settings, and age groups. Future research should explore barriers to adopting data collection and documentation tools and elicit input from agency directors, families, and others interested in reviewing data about adults with ASD.

Clinical decision support for intervention reduction in neonatal patients: A usability assessment.

Objective: This study investigated how effectively simplified cognitive walkthroughs, performed independently by four nonclinical researchers, can be used to assess the usability of clinical decision support software. It also helped illuminate the types of usability issues in clinical decision support software tools that cognitive walkthroughs can identify. Method: A human factors professor and three research assistants each conducted an independent cognitive walkthrough of a web-based demonstration version of T3, a physiologic monitoring system featuring a new clinical decision support software tool called MAnagement Application (MAP). They accessed the demo on personal computers in their homes and used it to walk through several pre-specified tasks, answering three standard questions at each step. Then they met to review and prioritize the findings. Results: Evaluators acknowledged several positive features including concise, helpful tooltips and an informative column in the patient overview which allows users direct (one-click) access to protocol eligibility and compliance criteria. Recommendations to improve usability include: modify the language to clarify what user actions are possible; visually indicate when eligibility flags are snoozed; and specify which protocol's data is currently being shown. Conclusion: Independent, simplified cognitive walkthroughs can help ensure that clinical decision support software tools will appropriately support clinicians. Four researchers used this technique to quickly, inexpensively, and effectively assess T3's new MAP tool, which suggests positive actions, such as removing a patient from a ventilator. Results indicate that, while there is room for usability improvements, the MAP tool may help reduce clinician's cognitive load, facilitating improved care. The study also confirmed that cognitive walkthroughs identify issues that make clinical decision support software hard to learn or remember to use.

Physician Perspectives on Severe Behavior and Restraint Use in a Hospital Setting for Patients with Autism Spectrum Disorder.

Hospitals, with many features that can evoke severe behavior in patients with autism spectrum disorder (ASD), often use restraint as a behavior management strategy. Prior research on restraint in patients with ASD has primarily focused on children or specific departments. Twenty-five physicians and medical trainees from an urban teaching hospital participated in discussions about experiences managing severe behavior in patients with ASD across the lifespan. Twenty themes emerged from thematic analysis of participant transcripts. The five most salient themes included: lack of procedural knowledge with restraint implemented by other hospital professionals; alternative strategies to manage severe behavior; negative perceptions of restraint; helpful role of caregivers; and limited experience treating patients with ASD, and critical need for training in function-based management.

Usability of Electronic Health Record-Generated Discharge Summaries: Heuristic Evaluation.

BACKGROUND: Obtaining accurate clinical information about recent acute care visits is extremely important for outpatient providers. However, documents used to communicate this information are often difficult to use. This puts patients at risk of adverse events. Elderly patients who are seen by more providers and have more care transitions are especially vulnerable. OBJECTIVE: This study aimed to (1) identify the information about elderly patients' recent acute care visits needed to coordinate their care, (2) use this information to assess discharge summaries, and (3) provide recommendations to help improve the quality of electronic health record (EHR)-generated discharge summaries, thereby increasing patient safety. METHODS: A literature review, clinician interviews, and a survey of outpatient providers were used to identify and categorize data needed to coordinate care for recently discharged elderly patients. Based upon those data, 2 guidelines for creating useful discharge summaries were created. The new guidelines, along with 17 previously developed medical documentation usability heuristics, were applied to assess 4 simulated elderly patient discharge summaries. RESULTS: The initial research effort yielded a list of 29 items that should always be included in elderly patient discharge summaries and a list of 7 "helpful, but not always necessary" items. Evaluation of 4 deidentified elderly patient discharge summaries revealed that none of the documents contained all 36 necessary items; between 14 and 18 were missing. The documents each had several other issues, and they differed significantly in organization, layout, and formatting. CONCLUSIONS: Variations in content and structure of discharge summaries in the United States make them unnecessarily difficult to use. Standardization would benefit both patients, by lowering the risk of care transition-related adverse events, and outpatient providers, by helping reduce frustration that can contribute to burnout. In the short term, acute care providers can help improve the quality of their discharge summaries by working with EHR vendors to follow recommendations based upon this study. Meanwhile, additional human factors work should determine the most effective way to organize and present information in discharge summaries, to facilitate effective standardization.

A graph for every analysis: Mapping visuals onto common analyses using flexplot.

For decades, statisticians and methodologists have insisted researchers utilize graphical analysis much more heavily. Despite cogent and passionate recommendations, there has been no graphical revolution. Instead, researchers rely heavily on misleading graphics that violate visual processing heuristics. Perhaps the main reason for the persistence of deceptive graphics is software; most software familiar to psychological researchers suffer from poor defaults and limited capabilities. Also, visualization is ancillary to statistical analysis, providing an incentive to not produce graphics at all. In this paper, we argue that every statistical analysis must have an accompanying graphic, and we introduce the point-and-click software Flexplot, available both in JASP and Jamovi. We then present the theoretical framework that guides Flexplot, as well as show how to perform the most common statistical analyses in psychological literature.

Transporting Children in Autonomous Vehicles: An Exploratory Study.

OBJECTIVE: Identify factors that impact parents' decisions about allowing an unaccompanied child to ride in an autonomous vehicle (AV). BACKGROUND: AVs are being tested in several U.S. cities and on highways in multiple states. Meanwhile, suburban parents are using ridesharing services to shuttle children from school to extracurricular activities. Parents may soon be able to hire AVs to transport children. METHOD: Nineteen parents of 8- to 16-year-old children, and some of their children, rode in a driving simulator in autonomous mode, then were interviewed. Parents also participated in focus groups. Topics included minimum age for solo child passengers, types of trips unaccompanied children might take, and vehicle features needed to support child passengers. RESULTS: Parents would require two-way audio communication and prefer video feeds of vehicle interiors, seatbelt checks, automatic locking, secure passenger identification, and remote access to vehicle information. Parents cited convenience as the greatest benefit and fear that AVs could not protect passengers during unplanned trip interruptions as their greatest concern. CONCLUSION: Manufacturers have an opportunity to design family-friendly AVs from the outset, rather than retrofit them to be safe for child passengers. More research, especially usability studies where families interact with technology prototypes, is needed to understand how AV design impacts child passengers. APPLICATION: Potential applications of this research include not only designing vehicles that can be used to safely transport children, seniors who no longer drive, and individuals with disabilities but also developing regulations, policies, and societal infrastructure to support safe child transport via AVs.

EEG correlates of task engagement and mental workload in vigilance, learning, and memory tasks.

INTRODUCTION: The ability to continuously and unobtrusively monitor levels of task engagement and mental workload in an operational environment could be useful in identifying more accurate and efficient methods for humans to interact with technology. This information could also be used to optimize the design of safer, more efficient work environments that increase motivation and productivity. METHODS: The present study explored the feasibility of monitoring electroencephalo-graphic (EEG) indices of engagement and workload acquired unobtrusively and quantified during performance of cognitive tests. EEG was acquired from 80 healthy participants with a wireless sensor headset (F3-F4,C3-C4,Cz-POz,F3-Cz,Fz-C3,Fz-POz) during tasks including: multi-level forward/backward-digit-span, grid-recall, trails, mental-addition, 20-min 3-Choice Vigilance, and image-learning and memory tests. EEG metrics for engagement and workload were calculated for each 1 -s of EEG. RESULTS: Across participants, engagement but not workload decreased over the 20-min vigilance test. Engagement and workload were significantly increased during the encoding period of verbal and image-learning and memory tests when compared with the recognition/ recall period. Workload but not engagement increased linearly as level of difficulty increased in forward and backward-digit-span, grid-recall, and mental-addition tests. EEG measures correlated with both subjective and objective performance metrics. DISCUSSION: These data in combination with previous studies suggest that EEG engagement reflects information-gathering, visual processing, and allocation of attention. EEG workload increases with increasing working memory load and during problem solving, integration of information, analytical reasoning, and may be more reflective of executive functions. Inspection of EEG on a second-by-second timescale revealed associations between workload and engagement levels when aligned with specific task events providing preliminary evidence that second-by-second classifications reflect parameters of task performance.

The influence of spatial context and the role of intentionality in the interpretation of animacy from motion.

We present three experiments investigating how spatial context influences the attribution of animacy to a moving target. Each of our displays contained a moving object (the target) that might, depending on the way it moved, convey the impression that it was alive (animate). We investigated the mechanisms underlying this attribution by manipulating the nature of the spatial context surrounding the target. In Experiment 1, the context consisted of a simple static dot (the foil), whose position relative to the target's trajectory was manipulated. With some foil positions--for example, when the foil was lying along the path traveled by the target--animacy judgments were elevated relative to control foil locations, apparently because this context supported the impression that the target was "reacting to" or was in some other way mentally influenced by the foil. In Experiment 2, contexts consisted of a static oriented rectangle (the "paddle"). On some trials, the target collided with the paddle in a way that seemed to physically account for the target's motion pattern (in the sense of having imparted momentum to it); this condition reduced animacy ratings. Experiment 3 was similar, except that the paddles themselves were in motion; again, animacy attribution was suppressed when the target's motion seemed to have been caused by a collision with the paddle. Hence, animacy attributions can be either elevated or suppressed by the nature of the environment and the target's interaction with it. Animacy attribution tracks intentionality attribution; contrary to some earlier proposals, we conclude that attributing animacy involves, and may even require, attributing to the target some minimal mental capacity sufficient to endow the target with intentionality.

Individuation of visual objects over time.

How does an observer decide that a particular object viewed at one time is actually the same object as one viewed at a different time? We explored this question using an experimental task in which an observer views two objects as they simultaneously approach an occluder, disappear behind the occluder, and re-emerge from behind the occluder, having switched paths. In this situation the observer either sees both objects continue straight behind the occluder (called "streaming") or sees them collide with each other and switch directions ("bouncing"). This task has been studied in the literature on motion perception, where interest has centered on manipulating spatiotemporal aspects of the motion paths (e.g. velocity, acceleration). Here we instead focus on featural properties (size, luminance, and shape) of the objects. We studied the way degrees and types of featural dissimilarity between the two objects influence the percept of bouncing vs. streaming. When there is no featural difference, the preference for straight motion paths dominates, and streaming is usually seen. But when featural differences increase, the preponderance of bounce responses increases. That is, subjects prefer the motion trajectory in which each continuously existing individual object trajectory contains minimal featural change. Under this model, the data reveal in detail exactly what magnitudes of each type of featural change subjects implicitly regard as reasonably consistent with a continuously existing object. This suggests a simple mathematical definition of "individual object:" an object is a path through feature-trajectory space that minimizes feature change, or, more succinctly, an object is a geodesic in Mahalanobis feature space.