Avoid equipment graveyards: rigorous process to improve identification and procurement of effective, affordable, and usable newborn devices in low-resource hospital settings.

BACKGROUND: Millions of newborns die annually from preventable causes, with the highest rates occurring in Africa. Reducing neonatal mortality requires investment to scale hospital care, which includes providing hospitals with appropriate technology to care for small and sick newborns. Expensive medical devices designed for high-resource settings often fail to withstand conditions in low-resource hospitals, including humidity, dust, frequent user turnover, complex maintenance, lack of stable power, or difficulty sourcing expensive consumables. Rigorous evaluation protocols are needed to identify effective, affordable, rugged, and easy-to-use medical devices appropriate for quality hospital-based newborn care in low-resource hospitals. METHODS: We developed an evidence-based technology review process to identify medical devices suitable for small and sick newborn care in low-resource hospitals. The eight-step process consists of: identifying devices needed for effective newborn care; defining Target Product Profiles (TPPs); identifying commercially-available products that may meet TPPs; conducting desk research to evaluate technologies against TPPs; performing technical performance verification testing under laboratory conditions; verifying technical performance after exposure to heat, humidity, dust, and power loss; performing usability evaluations with nurses, and qualifying devices that pass all steps. Devices were purchased, installed, and monitored in newborn wards across Kenya, Malawi, Nigeria, and Tanzania. RESULTS: Of 271 devices considered, only 45 (16.6%) met corresponding TPPs based on desk research. Thirty-nine were purchased and evaluated in the laboratory; five (12.8%) failed to meet TPPs. Thirty-four products passing laboratory evaluation underwent short-term environmental testing; only one (2.9%) device failed. Thirty-seven products underwent usability testing with 127 clinicians; surprisingly, 14 (37.8%) failed to meet TPPs. Twenty-three products passed all evaluations, and 2457 devices were installed across 65 newborn wards in Kenya, Malawi, Nigeria, and Tanzania. Continuous device monitoring reported minimal device failures, with failed devices typically returned to service within two days, resulting in an average uptime (service days divided by days installed) of 99%. CONCLUSION: An evidence-based device selection process can improve procurement of effective, affordable, rugged, usable newborn care devices for low-resource hospitals, and feedback to manufacturers can improve device quality. Similar processes could be adapted beyond newborn care to identify medical devices suitable for implementation in any low-resource setting.

The Usability of Face Coverings Used to Prevent the Spread of COVID-19.

OBJECTIVE: To describe the perceived usability and usability problems associated with face coverings used to prevent the spread of COVID-19. BACKGROUND: Since public health experts have now identified the appropriate use of facemasks as one of the critical elements in an effective COVID mitigation strategy, understanding how people use and care for them has become important. METHOD: Data were collected via a survey that was shared on social media to which 2148 people responded. Participants were asked to identify the category class of the face covering they most often wear, rate its usability, answer demographic information, and questions about their mask use and hygiene, and identify issues they may suffer in relation to face cover use. RESULTS: Overall, users appear to perceive their face coverings favorably from a usability and satisfaction standpoint, even though almost two-thirds of users indicated that they experienced discomfort and problems with glasses fogging with the most popular mask types. When considering demographic information, users' political party affiliation appears related to how they perceive the usability of their face covering. CONCLUSION: Designers should work to improve the fit and comfort properties of protective masks; evidence suggests the System Usability Scale may be a useful tool in those efforts. APPLICATION: Understanding mask design and behavioral issues related to their use can help in the development of masks and will maximize their acceptance and effectiveness in the field.

Summative Usability Assessments of STAR-Vote: A Cryptographically Secure e2e Voting System That Has Been Empirically Proven to Be Easy to Use.

BACKGROUND: From the project's inception, STAR-Vote was intended to be one of the first usable, end-to-end (e2e) voting systems with sophisticated security. To realize STAR-Vote, computer security experts, statistical auditors, human factors (HF)/human-computer interaction (HCI) researchers, and election officials collaborated throughout the project and relied upon a user-centered, iterative design and development process, which included human factors research and usability testing, to make certain the system would be both usable and secure. OBJECTIVE: While best practices in HF/HCI methods for design were used and all apparent usability problems were identified and fixed, summative system usability assessments were conducted toward the end of the user-centered design process to determine whether STAR-Vote is in fact easy to use. METHOD AND RESULTS: After collecting efficiency, effectiveness, and satisfaction measurements per ISO 9241-11's system usability criteria, an analysis of the data revealed that there is evidence for STAR-Vote being the most usable, cryptographically secure voting system to date when compared with the previously tested e2e systems: Helios, Prêt à Voter, and Scantegrity. CONCLUSION AND APPLICATION: STAR-Vote being one of the first e2e voting systems that is both highly usable and secure is a significant accomplishment, because tamper-resistant voting systems can be used in U.S. elections to ensure the integrity of the electoral process, while still ensuring that voter intent is accurately reflected in the cast ballots. Moreover, this research empirically shows that a complex, secure system can still be usable-meaning that implemented security is not an excuse for poor usability.

Is It Time to Go Positive? Assessing the Positively Worded System Usability Scale (SUS).

OBJECTIVE: The goal of the research presented in this paper was to determine if the positively worded System Usability Scale (SUS) can be used in place of the positively and negatively worded standard SUS instrument for the subjective assessment of usability, and whether the results found here replicate those of Sauro and Lewis. BACKGROUND: Sauro and Lewis' previous study found no evidence that responses to SUS items differed across the standard SUS and the modified, positively worded version of the SUS when participants assessed websites. This study replicates and extends this work by examining a large number of different systems with larger sample sizes to add to the generalizability of previous findings. METHODS: So that participants could retrospectively assess 20 products, the standard SUS was administered to 268 participants and the positive SUS to 698 participants. SUS scores were computed and the data analyzed using psychometric methods to explore how the two versions of the SUS differed. RESULTS: The standard and positive versions of the SUS yielded similar SUS scores. In addition, both versions of the scale demonstrated evidence in support of reliability and validity. CONCLUSION: Either version of the SUS can be used with confidence to measure subjective usability. Furthermore, the scores generated from both versions of the SUS can be directly compared. APPLICATIONS: In situations where cognitive load, participants' spoken language, or item consistency with other surveys being given may be a factor, the positive SUS is a viable alternative to the standard SUS.

How Human Factors Can Help Preserve Democracy in the Age of Pandemics.

OBJECTIVE: To describe user-centered voting systems that would support the safe conduct of voting in a pandemic environment. BACKGROUND: The COVID-19 pandemic has complicated our democratic processes. Voters and poll workers feel threatened by the potential dangers of voting in business-as-usual polling stations. Indeed, significant problems were encountered in the recent 2020 primary elections in Wisconsin, where the National Guard had to be mobilized because so few poll workers reported to work, and more than 90% of polling places had to remain closed. METHOD: We describe a number of possible user-centered solutions that would help protect voters and poll workers in times of pandemic, and also report the results of a survey that asked voters and poll workers about what kinds of systems might make them willing to vote. RESULTS: Political as well as safety considerations will need to be considered as these safer voting solutions are designed since, surprisingly, the kinds of solutions preferred depend on the political affiliation of the voters. CONCLUSION: Human factors professionals have a large role to play in realizing the safe, successful implementation of these user-centered systems. Good human factors analysis can help minimize the risk to voters and poll workers. Moreover, human factors methods can help safeguard democracy by creating safe and well-engineered environments that are conducive to voting in the age of pandemics. APPLICATION: Creating safe and effective voting solutions that protect voters and poll workers during pandemic outbreaks is crucial to the preservation of democracy.

Benefits of a physician-facing tablet presentation of patient symptom data: comparing paper and electronic formats.

BACKGROUND: Providing patient information to physicians in usable form is of high importance. Electronic presentation of patient data may have benefits in efficiency and error rate reduction for these physician facing interfaces. Using a cancer symptom measurement tool (the MD Anderson Symptom Inventory (MDASI)) we assessed the usability of patient data in its raw paper form and compared that to presentation on two electronic presentation formats of different sizes. METHODS: In two separate experiments, undergraduates completed two identical six-part questionnaires on two twenty-patient MDASI data sets. In Experiment 1, participants completed one questionnaire using a paper packet and the other questionnaire using an in-house designed iPad application. In Experiment 2, MDASI data was evaluated using an iPad and iPod Touch. Participants assessed the usability of the devices directly after use. In a third experiment, medical professionals evaluated the paper and iPad interfaces in order to validate the findings from Experiment 1. RESULTS: Participants were faster and more accurate answering questions about patients when using the iPad. The results from the medical professionals were similar. No appreciable accuracy, task time, or usability differences were observed between the iPad and iPod Touch. CONCLUSIONS: Overall, the use of our tablet interface increased the accuracy and speed that users could extract pertinent information from a multiple patient MDASI data set compared to paper. Reducing the size of the interface did not negatively affect accuracy, speed, or usability. Generalization of the results to other physician facing interfaces is discussed.

Toward user-centered assistive technologies for aging in place with cognitive impairment: a survey.

PURPOSE: To reduce the burden of Alzheimer's disease, the use of assistive technologies for patients and their informal caregivers is considered essential. However, these technologies are made as "one size fits all" instead of being tailored to accommodate people with varying degrees of cognitive impairment and those with diverse races/ethnicities. Thus, the aim of this survey was to determine whether the types of assistance needed most, and the technology used by those with cognitive impairment differed by race (White/non-Hispanics, Black or African Americans, and Hispanic/Latinos or Puerto Ricans) and severity of dementia (mild, moderate, severe). RESEARCH DESIGN AND METHODS: One hundred and eighty informal caregivers of people with different levels of severity of cognitive impairment and several different races/ethnicities filled out an online survey regarding assistance needed and technologies used. RESULTS: The results show that racial minorities considered the needs for assistance with Basic Activities of Daily Living as more important compared to White/non-Hispanics with mild dementia. Furthermore, Hispanic/Latinos or Puerto Ricans and White/non-Hispanics with severe dementia were shown to use technology that is designed to help with Instrumental Activities of Daily Living more than those with moderate dementia. Lastly, during COVID-19, devices to assist with walking, preparing meals and personal hygiene have been used significantly more by White/non-Hispanics with severe dementia compared to Hispanic/Latinos or Puerto Ricans. CONCLUSION: The results point to the need to design for those with severe dementia, regardless of race, and should focus on addressing needs related to both Instrumental and Basic Activities of Daily Living.

Developers of assistive technology should consider designing technology that can accommodate all severity levels of cognitive impairment.More research is needed to determine the usability of assistive technology that is designed for those with cognitive impairments.

The impact of inaccurate Internet health information in a secondary school learning environment.

BACKGROUND: Patients in the United States commonly use the Internet to acquire health information. While a significant amount of health-related information is available on the Internet, the accuracy of this information is highly variable. OBJECTIVES: The objective of the study was to determine how effectively students can assess the accuracy of Internet-based material when gathering information on a controversial medical topic using simple keyword searches. METHODS: A group of 34 students from the science magnet high school in Houston, Texas searched for the terms "vaccine safety" and "vaccine danger" using Google and then answered questions regarding the accuracy of the health information on the returned sites. The students were also asked to describe the lessons they learned in the exercise and to answer questions regarding the strength of evidence for seven statements regarding vaccinations. Because of the surprising revelation that the majority of students left the exercise with inaccurate information concerning the safety and efficacy of vaccines, these same students participated in a follow-up study in which a fact-based vaccine video was shown, after which the assessment of student knowledge was repeated. RESULTS: Of the 34 participants, 20 (59%) thought that the Internet sites were accurate on the whole, even though over half of the links (22 out of 40, 55%) that the students viewed were, in fact, inaccurate on the whole. A high percentage of the students left the first exercise with significant misconceptions about vaccines; 18 of the 34 participants (53%) reported inaccurate statements about vaccines in the lessons they learned. Of the 41 verifiable facts about vaccines that were reported by participants in their lessons-learned statement, 24 of those facts (59%) were incorrect. Following presentation of the film, the majority of students left the exercise with correct information about vaccines, based on their lessons-learned statement. In this case, 29 of the 31 participants (94%) reported accurate information about vaccines. Of the 49 verifiable facts about vaccines that were reported by participants, only 2 (4%) were incorrect. Students had higher correct scores in the "strength of evidence" exercise following exposure to the video as well. CONCLUSIONS: Allowing students to use the Internet to gain information about medical topics should be approached with care since students may take away predominantly incorrect information. It is important to follow up conflicting information with a solid, unambiguous message that communicates those lessons that the instructor deems most important. This final message should be fact based but may need to contain an anecdotal component to counter the strong emotional message that is often delivered by inaccurate Internet sites.

Evaluation of Home Health Care Devices: Remote Usability Assessment.

BACKGROUND: An increasing amount of health care is now performed in a home setting, away from the hospital. While there is growing anecdotal evidence about the difficulty patients and caregivers have using increasingly complex health care devices in the home, there has been little systematic scientific study to quantify the global nature of home health care device usability in the field. Research has tended to focus on a handful of devices, making it difficult to gain a broad view of the usability of home-care devices in general. OBJECTIVE: The objective of this paper is to describe a remote usability assessment method using the System Usability Scale (SUS), and to report on the usability of a broad range of health care devices using this metric. METHODS: A total of 271 participants selected and rated up to 10 home health care devices of their choice using the SUS, which scores usability from 0 (unusable) to 100 (highly usable). Participants rated a total of 455 devices in their own home without an experimenter present. RESULTS: Usability scores ranged from 98 (oxygen masks) to 59 (home hormone test kits). An analysis conducted on devices that had at least 10 ratings showed that the effect of device on SUS scores was significant (P<.001), and that the usability of these devices was on the low end when compared with other commonly used items in the home, such as microwave ovens and telephones. CONCLUSIONS: A large database of usability scores for home health care devices collected using this remote methodology would be beneficial for physicians, patients, and their caregivers.

Developing and validating a self-report assessment tool for software biomechanics.

BACKGROUND: There are many effective methods for decreasing the likelihood of repetitive strain injury (RSI) for those who work at a computer in an office environment. This study is focused on the highly repetitive task of interpreting seismic data. The skilled geoscientists who perform this work are very well compensated, and their work is vital to the success of the oil company. However, RSIs are still occurring in situations where effective methods of mitigating injuries have been successfully implemented and this has been occurring very frequently for geoscientists. This suggests that there are other elements contributing to the development of these injuries and one element could be the software interaction design. However, it is difficult for software designers to determine this because most measures associated with muscle activity require expensive data collection methods. OBJECTIVE: This paper describes research conducted to determine if survey-based subjective measures might be used to assess the potential for RSI for software programs. METHODS: In laboratory and field settings, data were collected using three different survey instruments (NASA-Task Load Index, Latko's Busiest Hand Activity Level Scale, and the Borg CR10 Rating of Perceived Exertion Scale) and conventional measures of muscle activity (sEMG). Correlations between the surveys and muscle activity were then calculated. RESULTS: For both the laboratory and the field, people were able to provide reliable self-report information related to their muscle activity. However, the effect sizes were not large. CONCLUSIONS: These results suggest that self-report tools could be utilized to identify software interaction designs related associated with risks of RSI.

Toward more usable electronic voting: testing the usability of a smartphone voting system.

OBJECTIVE: The goal of this research was to assess the usability of a voting system designed for smart-phones. BACKGROUND: Smartphones offer remote participation in elections through the use of pervasive technology. Voting on these devices could, among other benefits, increase voter participation while allowing voters to use familiar technology. However, the usability of these systems has not been assessed. METHOD: A mobile voting system optimized for use on a smartphone was designed and tested against traditional voting platforms for usability. RESULTS: There were no reliable differences between the smartphone-based system and other voting methods in efficiency and perceived usability. More important, though, smartphone owners committed fewer errors on the mobile voting system than on the traditional voting systems. CONCLUSION: Even with the known limitations of small mobile platforms in both displays and controls, a carefully designed system can provide a usable voting method. Much of the concern about mobile voting is in the area of security; therefore, although these results are promising, security concerns and usability issues arising from mitigating them must be strongly considered. APPLICATION: The results of this experiment may help to inform current and future election and public policy officials about the benefits of allowing voters to vote with familiar hardware.

The effect of content desirability on subjective video quality ratings.

OBJECTIVE: The purpose of this study was to examine the impact of the desirability of content on viewers' ratings of subjective video quality. BACKGROUND: Most subjective video quality studies use short-duration clips that are specially designed to exercise the encoding algorithms and do not consider the desirability of the content as a variable. METHOD: In four studies, we employed a total of 100 participants and 180 movie clips encoded at nine levels from 550 kbps up to DVD quality. Participants viewed clips that were 2 min in length and then were asked about video quality of the clips and desirability of the movie content. RESULTS: The results of these studies show that there is a strong correlation between the desirability of movie content and subjective ratings of video quality. This strong relationship holds across a wide range of encoding levels and movie content when that content is viewed under longer, more naturalistic viewing conditions. CONCLUSION: The effects of content should be considered when evaluating the subjective quality of encoded video content, as these effects can be as large as those seen between low- and high-quality encodings. APPLICATION: Researchers and practitioners trying to determine acceptable levels of video quality for actual consumption by consumers may find that the results and methods described here allow for a more accurate assessment of levels of video quality that are acceptable in a fielded service.