Using EEG to investigate the influence of boredom on prospective memory in top-down and bottom-up processing mechanisms for intelligent interaction.

We aimed to investigate the alpha (α) activity in operators experiencing boredom while performing prolonged monitoring and prospective memory tasks using different processing mechanisms. Fifty-four participants underwent electroencephalography (EEG) and were found to have poorer prospective memory performance under top-down conditions. Further, α power and synchronisation were higher during bottom-up than in top-down processes, revealing an inhibition effect of the former. Significant differences in brain regions and hemispheres were identified to distinguish different cognitive processes in both information-processing mechanisms. Thus, people are likely to cope with boredom differently in terms of top-down and bottom-up processes. Specifically, a higher attention level was reported during top-down processing, to mitigate the negative influences of boredom. Overall, this study provides EEG evidence which suggests that prospective memory can be enhanced in top-down processing during prolonged monitoring tasks by increasing the salience of cues.

Boredom is a growing problem as tasks requiring monitoring increase. We explored how people process information to perform prospective memory tasks while monitoring. The prospective memory was poorer during top-down processing, but stronger cortical activation indicated an inhibitory effect on inattention. Information-processing mechanisms are suggested for designing boredom interventions.

Do Congruent Auditory Stimuli Facilitate Visual Search in Dynamic Environments? An Experimental Study Based on Multisensory Interaction.

The purpose of this study was to investigate the cue congruency effect of auditory stimuli during visual search in dynamic environments. Twenty-eight participants were recruited to conduct a visual search experiment. The experiment applied auditory stimuli to understand whether they could facilitate visual search in different types of background. Additionally, target location and target orientation were manipulated to clarify their influences on visual search. Target location was related to horizontal visual search and target orientation was associated with visual search for an inverted target. The results regarding dynamic backgrounds reported that target-congruent auditory stimuli could speed up the visual search time. In addition, the cue congruency effect of auditory stimuli was critical for the center of the visual display but declined for the edge, indicating the inhibition of horizontal visual search behavior. Moreover, few improvements accompanying auditory stimuli were provided for the visual detection of non-inverted and inverted targets. The findings of this study suggested developing multisensory interaction with head-mounted displays, such as augmented reality glasses, in real life.

Alpha Oscillations in Parietal and Parietooccipital Explaining How Boredom Matters Prospective Memory.

Intelligent interaction alters previous human-machine task allocation patterns. Human workers will suffer from boredom and inattention, posing a significant challenge for the human-machine interaction loop. This study aims to investigate the relationship between boredom and prospective memory, which is a memory form including the detecting, identifying, and executing functions. Thus, the attention and memory mechanisms are critical to complete prospective memory tasks when bored. This study recruited twenty-eight participants and used electroencephalography to measure the alpha power in brain regions. The results indicated that parietal oscillations had a mediation effect on prospective memory, which could be associated with the frequent unstable attention. In addition, this study found that parietooccipital oscillations linked boredom and prospective memory, and the default mode network (DMN) and visual processing during boredom could better explain this finding. The findings of this study suggested that attention management and influences of processing visual information were starting points to cope with boredom because they could help prepare for prospective memory and make optimal decisions accordingly.

Comparing interventions to reduce boredom in a low mental workload environment.

Boredom is a common workplace problem. Previous research has suggested that repetitive and monotonous work tasks may lead to boredom. However, these tasks have been reduced due to increased workplace automation. Thus, the current cause of boredom may be due to low mental workload. This research developed a general boredom model and compared the effects of feedback type (performance and ranking) and intervention method (game and quiz) on boredom and task performance. Results revealed that the secondary task interventions can reduce boredom and feedback could shorten the response time. Gender also had a significant influence on response time. Notably, results revealed a 4% probability of task failure during the experiment, indicating other interventions are also required. This research indicates that interventions to reduce boredom caused by low mental workload should be designed differently from tasks that have been designed to combat the boredom caused by repetitive and monotonous work.

Prevalence of musculoskeletal discomfort among female cabin crew in Taiwan.

OBJECTIVES: This study investigated the prevalence of musculoskeletal discomfort among female cabin crew through cabin tasks and demographic factors, including age and seniority. METHODS: This study conducted an online questionnaire survey targeted at female cabin crew in Taiwan and ensured that the sample size was with a statistical power of 0.95. This study evaluated the work intensity by ranking six common cabin tasks and examined musculoskeletal discomfort with Cornell Musculoskeletal Discomfort Questionnaire. Descriptive statistics were used to learn the work intensity and discomfort conditions. In addition, the Chi-square test of independence and multivariate adjustment were applied to clarify the impact of age and occupation on musculoskeletal discomfort in the neck, shoulders, and lower back. RESULTS: This study enrolled 88 female cabin crew members. Handling carry-on baggage was voted as the highest intensity cabin task (40%), which was also ranked as the strongest intensity on shoulders. Meanwhile, the upper trunk was more prevalent in musculoskeletal discomfort. Moreover, after multivariate adjustment with controlling the effect of age, this study found a marginal significant association (p = .09) between seniority and right shoulder discomfort for younger staff. CONCLUSION: This study found that handling carry-on baggage was associated with musculoskeletal complaints in the shoulders. Therefore, this study suggested that shoulders, especially for the right side might be related to the occupational injury, which was prevalent along with seniority among the younger crew. Overall, this study provided the preliminary findings to improve occupational training for preventive health.

Regional differences in the effect of interpersonal relationship on trust and trustworthiness in China.

Guanxi, which literally means interpersonal relationship or social connections, plays an important role in achieving business success in China. This study investigates the effect of interpersonal relationship on trust and trustworthiness in four regions in China. Eighty pairs of close friends participated in the experiment: 20 pairs from Beijing, 20 pairs from Guangdong, 20 pairs from Shanghai, and 20 pairs from Chongqing. A cooperation experiment based on a two-tier simulated supply chain was conducted, in which the participant who played as a supplier solicited demand forecast information from the participant who played as a retailer to plan production. Participants were instructed to perform two tasks: one with a "friend" counterpart and one with a "stranger" counterpart. The results demonstrated regional differences in the effects of interpersonal relationship on trust and trustworthiness: the effect of interpersonal relationship was greater in Guangdong than in the other regions. Additionally, a quantified classification of trustworthiness-trust was proposed by clustering analysis. The type of self-protective trustworthiness and altruistic trust occupied an overwhelming majority in each region, followed by the type of altruistic trustworthiness and self-protective trust, the type of altruistic trustworthiness and altruistic trust, and the type of self-protective trustworthiness and self-protective trust. Regional differences in the distribution proportions in the four types were discovered.

Influence of semantic cues on hazard-inspection performance: a case in construction safety.

Constant improvement in hazard identification is key to personnel safety in the workplace. Semantic cues have been proposed to simplify knowledge retrieval for site inspectors in building construction. However, the effectiveness of this approach and its internal mechanisms remain unexamined. This study assesses the influence of semantic cues on inspection performance from the perspective of visual behavior during elevator installation. Our results indicate that semantic cues drive selective attention toward goal-relevant information more effectively compared with when no such cues are provided. Second, semantic cues can improve performance regarding goal-relevant hazards and not diminish performance for incidental hazards. Third, the improvement of working memory and inspection performance is more pronounced in experienced workers than in novices. This research highlights the influence of semantic cues for hazard identification on visual behavior and inspection performance, and can serve as a foundation for the allocation of resources to aid inspection during construction.

Cognitive Behavioral Therapy-Based Short-Term Abstinence Intervention for Problematic Social Media Use: Improved Well-Being and Underlying Mechanisms.

Problematic social media use is detrimental to users' subjective well-being. Based on cognitive behavioral therapy (CBT), we proposed a short-term abstinence intervention to treat this problem. A mixed method study with 65 participants was conducted to examine the effectiveness of this intervention and to reveal the underlying mechanisms of how the intervention influences participants. While the experimental group (N = 33) took eight 2.5-h breaks from social media over two weeks and had daily dairies, the control group (N = 32) used social media as usual and had daily diaries. The results demonstrated that the intervention has a positive effect on life satisfaction. The effect varied with the time users conducted abstinence (work hours vs. off hours) and the level of social media addiction (heavy users vs. normal users). Qualitative findings from dairies and interviews unveiled associations among users' behaviors, feelings, and cognitions during and after abstinence. These results extend the understanding of the CBT-based short-term abstinence intervention and suggest opportunities to alleviate problematic social media use.

Leveraging Walking Performance to Understand Work Fatigue Among Young Adults: Mixed-Methods Study.

BACKGROUND: Work fatigue negatively impacts personal health in the long term. Prior research has indicated the possibility of leveraging both walking parameters and perceptual measures to assess a person's fatigue status. However, an effective and ubiquitous approach to assessing work fatigue in young adults remains unexplored. OBJECTIVE: The goals of this paper were to (1) explore how walking rhythms and multiple streams of data, including reaction time, self-reports, and an activity diary, reflect work-induced fatigue in the lab setting; (2) identify the relationship between objective performance and subjective perception in indicating fatigue status and fatigability; and (3) propose a mobile-based assessment for work-induced fatigue that uses multiple measurements. METHODS: We conducted a 2-day in-lab study to measure participants' fatigue status using multiple measurements, including the stair climb test (SCT), the 6-minute walk test (6MWT), and the reaction time test. Both the SCT and the 6MWT were conducted at different points in time and under 2 conditions (measurement time, including prior to and after work, and pace, including normal and fast). Participants reported their fatigue perception through questionnaires completed before conducting walking tests and in an activity diary recorded over a week. Walking performance data were collected by a smartphone with a built-in 3-axis accelerometer. To examine the effect of fatigability on walking performance, we first clustered participants into 2 groups based on their reported mental fatigue level in the entry surveys and then compared their walking performance using a generalized linear model (GLM). The reaction time was examined using a 2-way repeated-measures GLM. We conducted semistructured interviews to understand participants' fatigue perception after each day's walking tests. RESULTS: All participants (N=26; mean age 24.68 years) were divided into 2 groups-the fatigue-sensitive group (11/26, 42%) and the fatigue-nonsensitive group (15/26, 58%)-based on their mental subscores from 3 entry surveys: Fatigue Scale-14, Three-Dimensional Work Fatigue Inventory, and Fatigue Self-Assessment Scale (FSAS). The fatigue-sensitive group reported a significantly higher FSAS score in the before-work setting (t50=-3.361; P=.001). The fatigue-sensitive group covered fewer steps than the fatigue-nonsensitive group (ß1=-0.099; SE 0.019; t1=-5.323; P<.001) and had a higher step-to-step time variability in the 6MWT (ß1=9.61 × 10-4; t1=2.329; P=.02). No strong correlation between subjective and objective measurements was observed in the study. CONCLUSIONS: Walking parameters, including step counts and step-to-step time variability, and some selected scales (eg, FSAS) were found to reflect participants' work-induced fatigue. Overall, our work suggests the opportunity of employing mobile-based walking measurements to indicate work fatigue among young adults.

General and passenger-relevant factors of work-related musculoskeletal disorders (WMSDs) among Chinese female flight attendants.

BACKGROUND: A high prevalence of work-related musculoskeletal disorders (WMSDs) has been reported among flight attendants. Identifying the root causes of these disorders may improve the health conditions of flight attendants and further improve flight safety and service quality. OBJECTIVE: In this study, we aimed to identify WMSD risk factors for a specific population, namely Chinese female flight attendants. METHODS: A two-stage survey including an online questionnaire (46 flight attendants) and a semi-structured interview (16 flight attendants) was used to assess the WMSDs of Chinese female flight attendants. Text analysis tools in NVivo 11 were used to identify the main concerns and risk factors for WMSDs of Chinese flight attendants. RESULTS: In the online questionnaire, more than 86% of the participants reported discomfort in at least one body part. Biomechanical factors, work organizational factors, and psychosocial factors were reported by participants in this study. Chinese passengers were found to have an effect on WMSD development in Chinese flight attendants. CONCLUSIONS: The results of this study suggested that WMSDs are severe problems among Chinese flight attendants. General factors as well as the passenger-relevant factor were identified as the most influential causes of WMSDs.

A Mobile Phone-Based Gait Assessment App for the Elderly: Development and Evaluation.

BACKGROUND: Gait disorders are common among older adults. With an increase in the use of technology among older adults, a mobile phone app provides a solution for older adults to self-monitor their gait quality in daily life. OBJECTIVE: This study aimed to develop a gait-monitoring mobile phone app (Pocket Gait) and evaluate its acceptability and usability among potential older users. METHODS: The app was developed to allow older adults to track their gait quality, including step frequency, acceleration root mean square (RMS), step regularity, step symmetry, and step variability. We recruited a total of 148 community-dwelling older adults aged 60 years and older from two cities in China: Beijing and Chongqing. They walked in three ways (single task, dual task, and fast walking) using a smartphone with the gait-monitoring app installed and completed an acceptability and usability survey after the walk test. User acceptability was measured by a questionnaire including four quantitative measures: perceived ease of use, perceived usefulness, ease of learning, and intention to use. Usability was measured using the System Usability Scale (SUS). Interviews were conducted with participants to collect open-ended feedback questions. RESULTS: Task type had a significant effect on all gait parameters, namely, step frequency, RMS, step variability, step regularity, and step symmetry (all P values <.001). Age had a significant effect on step frequency (P=.01), and region had a significant effect on step regularity (P=.04). The acceptability of the gait-monitoring app was positive among older adults. Participants identified the usability of the system with an overall score of 59.7 (SD 10.7) out of 100. Older adults from Beijing scored significantly higher SUS compared with older adults from Chongqing (P<.001). The age of older adults was significantly associated with their SUS score (P=.048). Older adults identified improvements such as a larger font size, inclusion of reference values for gait parameters, and inclusion of heart rate and blood pressure monitoring. CONCLUSIONS: This mobile phone app is a health management tool for older adults to self-manage their gait quality and prevent adverse outcomes. In the future, it will be important to take factors such as age and region into consideration while designing a mobile phone-based gait assessment app. The feedback of the participants would help to design more elderly-friendly products.

Development and Preliminary Usability Evaluation of a Somatosensory Square Dance System for Older Chinese Persons: Mixed Methods Study.

BACKGROUND: Chinese square dancing, known as guangchang wu in Chinese, is a well-known public fitness activity that provides an entertaining way for older Chinese women to improve their flexibility, lower extremity strength, overall coordination, and balance. However, injuries, noise conflicts, and lack of space are challenging aspects of this activity. Somatosensory games (SG) are an increasingly popular physical fitness approach to enhance the selective attention of older persons with indoor engagement and exercises. OBJECTIVE: The objectives of this study were to develop a newly designed somatosensory square dance system for older Chinese people and to evaluate its usability. METHODS: This is a mixed methods study. The newly designed somatosensory square dance system is a somatic training tool that provides adequate Chinese square dance fitness training based on Laban Movement Analysis (LMA) and design guidelines established in a previous stage. The usability evaluation involved a questionnaire and interviews. Twelve participants were interviewed before and after experiencing the 15-minute dancing and learning process within the program. In addition, participants scored their experience satisfaction in psychological, physiological, and relaxation sections on a scale of 1 to 5 using a questionnaire. Qualitative content analysis and quantitative analysis of the satisfaction scores supported understanding of usability problems. RESULTS: Based on the interview results, 6/12 (50%) of the participants thought the system could help them correct their dancing movements indoors without being affected by poor outdoor weather. Among the participants, 3/12 (25%) indicated that this indoor system could enable them to enjoy fitness activities in a private space. Moreover, 3/12 participants (25%) stated that this system could promote family relationships by providing easy dancing movements. All participants were highly satisfied with the relaxation aspect of the system (4.45/5). The participants were all psychologically satisfied and interested in the novel features of the system, with an average score of 4.16/5. Physiologically, participants affirmed that the system could help them maintain good health (4.91/5). CONCLUSIONS: The results of this study suggest that the somatosensory square dance system can be used as an indoor fitness tool to improve older Chinese square dancers' health conditions with reasonable dance training. Noise and space conflicts can be addressed. The Laban Elated Square Dance system, which was modified by therapists based on LMA and square dance design guidelines, was highly approved by dancers because it decreased the possibility of injuries, falls, and joint damage by considering the physical and psychological difficulties of older persons. Different features will be considered in the next stage, such as greater selection of exercises and difficulty level settings. Users' social needs will also be explored in subsequent stages.

Cross-modal psychological refractory period in vision, audition, and haptics.

People's parallel-processing ability is limited, as demonstrated by the psychological refractory period (PRP) effect: The reaction time to the second stimulus (RT2) increases as the stimulus onset asynchrony (SOA) between two stimuli decreases. Most theoretical models of PRP are independent of modalities. Previous research on PRP mainly focused on vision and audition as input modalities; tactile stimuli have not been fully explored. Research using other paradigms and involving tactile stimuli, however, found that dual-task performance depended on input modalities. This study explored PRP with all the combinations of input modalities. Thirty participants judged the magnitude (small or large) of two stimuli presented in different modalities with an SOA of 75-1,200 ms. PRP effect was observed, i.e., RT2 increased with a decreasing SOA, in all the modalities. Only in the auditory-tactile condition did the accuracy of Task 2 decrease with a decreasing SOA. In the auditory-tactile and tactile-visual conditions, RT to the first stimulus also increased with a decreasing SOA. Current models could only explain part of the results, and modality characteristics help to explain the overall data pattern better. Limitations and directions for future studies regarding reaction time, task difficulty, and response modalities are discussed.

Spatially incongruent sounds affect visual localization in virtual environments.

Distance underestimations along the depth plane are widely found in virtual environments. However, past findings have shown that changes in the visual aspects of virtual reality settings do not lead to more accurate depth estimates. Therefore, we examined if nonvisual stimuli, namely, sounds, could serve as cues that affect observers' depth perception. Accordingly, we conducted two distance discrimination tasks to examine whether observers' depth localization is affected by a spatially incongruent sound. In Experiment 1, a spatially incongruent sound made a visual target appear farther away than a visual target presented with no sound only when a far-distance range (i.e., longer than 12 m) was introduced. Experiment 2 further indicated that the sound shifted visual localization only when audiovisual spatial disparity did not exceed 4°. Taken together, our findings suggest that the depth localization of a visual object in virtual reality can be altered by a spatially incongruent sound, and provide a potential approach that we can adopt a spatially incongruent sound as a cue to reduce the depth compression in VR.

Haptic and Auditory-Haptic Attentional Blink in Spatial and Object-Based Tasks.

Dual-task performance depends on both modalities (e.g., vision, audition, haptics) and task types (spatial or object-based), and the order by which different task types are organized. Previous studies on haptic and especially auditory-haptic attentional blink (AB) are scarce, and the effect of task types and their order have not been fully explored. In this study, 96 participants, divided into four groups of task type combinations, identified auditory or haptic Target 1 (T1) and haptic Target 2 (T2) in rapid series of sounds and forces. We observed a haptic AB (i.e., the accuracy of identifying T2 increased with increasing stimulus onset asynchrony between T1 and T2) in spatial, object-based, and object-spatial tasks, but not in spatial-object task. Changing the modality of an object-based T1 from haptics to audition eliminated the AB, but similar haptic-to-auditory change of the modality of a spatial T1 had no effect on the AB (if it exists). Our findings fill a gap in the literature regarding the auditory-haptic AB, and substantiate the importance of modalities, task types and their order, and the interaction between them. These findings were explained by how the cerebral cortex is organized for processing spatial and object-based information in different modalities.

Personality factors and safety attitudes predict safety behaviour and accidents in elevator workers.

Elevator accidents happen frequently and cause much loss. Personality factors and safety attitudes have been proved effective in predicting accidents in traffic and the workplace. The present study aimed to explore the effect of personality factors and safety attitudes in elevator accidents. A survey was carried out on 383 elevator installers and repairers in China, measuring personalities (conscientiousness, agreeableness and trait anxiety), safety attitudes (compliant and proactive), safety behaviours and accidents (occupational injuries). Approximately 60% of the elevator workers had been injured in the past 6 months. The structural equation model suggested that conscientiousness could predict compliant safety behaviour both directly and indirectly through safety attitude and could predict proactive safety behaviour. Agreeableness could predict compliant safety behaviour. Trait anxiety could predict occupational injuries. Recruiters should choose elevator workers who are conscientious, agreeable and of low trait anxiety. Safety trainings for elevator workers should focus on culturing their safety attitude.

Are cost-effective technologies feasible to measure gait in older adults? A systematic review of evidence-based literature.

BACKGROUND: Unrestricted by time and place, innovative technologies seem to provide cost-effective solutions for gait assessment in older adults. OBJECTIVE: The objective of this study is to provide an overview of gait assessment for older adults by investigating critical gait characteristics of older adults, discussing advantages and disadvantages of the current gait assessment technologies, as well as device applicability. METHODS: The Preferred Reporting Item for Systematic Reviews and Meta-Analysis (PRISMA) guidelines were followed during the review. Inclusion criteria were: (1) Sample consisting of adults older than 60 years; (2) qualitative, quantitative, or mixed-method researches using one or more specific gait assessment technologies; and (3) publication in English between 2000 and 2018. RESULTS: In total, twenty-one studies were included. Gait speed, stride length, frequency, acceleration root mean square, step-to-step consistency, autocorrelation, harmonic ratio were reported in the existing literatures to be associated with falls. The enrolled studies address the use of pedometer, wearable accelerometer-based devices, Kinect, Nintendo Wii Balance Board as cost-effective gait assessment technologies. CONCLUSIONS: Gait parameters and assessment approaches for older adults are diverse. Cost-effective technologies such as a wearable accelerometer-based device, Kinect, and the Nintendo Wii Balance Board provide potential alternatives for gait assessment with acceptable validity and reliability compared with sophisticated devices. The popularity and development of cost-effective devices have made large-scale data collection for gait assessment possible in the daily environment. Further study could involve older adults and their family members/caregivers in use of these technologies to design elderly-friendly products.

Determining fidelity of mixed prototypes: Effect of media and physical interaction.

Mixed prototyping, combining virtual and physical prototypes, is an emerging method used to aid in usability testing. This study aims to determine when to use a mixed prototype and how to choose its fidelity to validate the usability testing results and reduce the prototyping cost. A 2×2 between-subject experiment was designed to investigate the effects of the media (head-mounted display versus computer monitor) and physical interaction (using a tangible mock-up or not) on the usability evaluation results and other subjective measures. The experiment results showed that, when aesthetic and functional features are controlled, the non-functional mock-up facilitates users in finding problems regarding physical interaction and ergonomics. Media with high immersion positively influenced the users' subjective ratings. Based on the findings of this study, guidelines on how to choose the fidelity of the prototype during different stages of a usability test are suggested to help product developers find a cost-efficient way to conduct usability tests.

Application of smart bracelet to monitor frailty-related gait parameters of older Chinese adults: A preliminary study.

AIM: Smart bracelets are popular today. Based on their built-in motion sensors, they can serve as a cost-effective method of gait assessment in home-based care. Few studies have applied smart bracelets in the gait assessment of older Chinese adults. The present study aimed to: (i) establish reference gait parameters of older Chinese adults using smart bracelets under single and dual task; and (ii) explore the differences in gait parameters among non-frail and pre-frail Chinese older adults. METHODS: A total of 50 community-dwelling older Chinese adults aged ≥50 years wore a smart bracelet sensor in the L3 region of the back and underwent a 10-m walking test under single- and dual-task conditions. Participants were preliminarily classified into non-frail and pre-frail groups based on the Fatigue, Resistance, Ambulation, Illnesses and Loss of Weight scale. Gait parameters including average walking speed, step frequency, root mean square (RMS), acceleration amplitude variability, step variability, step regularity and step symmetry were calculated based on the data exported from the bracelet. RESULTS: Multivariate analysis of covariance (mancova) analysis showed that older adults had significantly decreased speed and step frequency (P < 0.05) under the dual cognitive task condition. Pre-frail older adults showed significantly decreased speed, mediolateral RMS, vertical RMS, anteroposterior RMS, vertical amplitude variability and vertical step regularity compared with non-frail older adults (P < 0.05). CONCLUSIONS: The present study suggested that the decline in gait parameters as a result of frailty could be detected by the smart bracelet sensor. Geriatr Gerontol Int 2018; 18: 1366-1371.

Factors determining perceptions of fairness in access to hospital outpatient departments in Taiwan.

Objectives To investigate the effects of four factors on perceptions of fairness in access to outpatient services: proportions of walk-in versus scheduled registration, consultation queues, regulations for late patients and particular categories of patients getting better access. Methods A total of 124 young adults were asked to consider nine different scenarios and report their views of the fairness of each one. Results As regards the balance of types of patients, 60% walk-in registration was seen as fair to both walk-in and scheduled patients. The fairness to both types of patients was higher in the queue with a 1:1 ratio of walk-in to scheduled patients. The policy that a late patient should wait for three on-time patients to be seen was considered to be fair to both on-time and late patients. Immediate consultation for some particular categories of patient (e.g. the elderly) was fair, but for other categories was unfair (e.g. paying an addition amount). Conclusions Fairness in outpatient care is based on equality and need principles. Shorter waiting time does not mean patients view the system as fairer.