Improving usability benchmarking for the eHealth domain: The development of the eHealth UsaBility Benchmarking instrument (HUBBI).

BACKGROUND: Currently, most usability benchmarking tools used within the eHealth domain are based on re-classifications of old usability frameworks or generic usability surveys. This makes them outdated and not well suited for the eHealth domain. Recently, a new ontology of usability factors was developed for the eHealth domain. It consists of eight categories: Basic System Performance (BSP), Task-Technology Fit (TTF), Accessibility (ACC), Interface Design (ID), Navigation & Structure (NS), Information & Terminology (IT), Guidance & Support (GS) and Satisfaction (SAT). OBJECTIVE: The goal of this study is to develop a new usability benchmarking tool for eHealth, the eHealth UsaBility Benchmarking Instrument (HUBBI), that is based on a new ontology of usability factors for eHealth. METHODS: First, a large item pool was generated containing 66 items. Then, an online usability test was conducted, using the case study of a Dutch website for general health advice. Participants had to perform three tasks on the website, after which they completed the HUBBI. Using Partial Least Squares Structural Equation Modelling (PLS-SEM), we identified the items that assess each factor best and that, together, make up the HUBBI. RESULTS: A total of 148 persons participated. Our selection of items resulted in a shortened version of the HUBBI, containing 18 items. The category Accessibility is not included in the final version, due to the wide range of eHealth services and their heterogeneous populations. This creates a constantly different role of Accessibility, which is a problem for a uniform benchmarking tool. CONCLUSIONS: The HUBBI is a new and comprehensive usability benchmarking tool for the eHealth domain. It assesses usability on seven domains (BSP, TTF, ID, NS, IT, GS, SAT) in which a score per domain is generated. This can help eHealth developers to quickly determine which areas of the eHealth system's usability need to be optimized.

Patient administrative burden in the US health care system.

OBJECTIVE: To assess the prevalence of patient administrative tasks and whether they are associated with delayed and/or foregone care. DATA SOURCE: March 2019 Health Reform Monitoring Survey. STUDY DESIGN: We assess the prevalence of five common patient administrative tasks-scheduling, obtaining information, prior authorizations, resolving billing issues, and resolving premium problems-and associated administrative burden, defined as delayed and/or foregone care. Using multivariate logistic models, we examined the association of demographic characteristics with odds of doing tasks and experiencing burdens. Our outcome variables were five common types of administrative tasks as well as composite measures of any task, any delayed care, any foregone care, and any burden (combined delayed/foregone), respectively. DATA COLLECTION: We developed and administered survey questions to a nationally representative sample of insured, nonelderly adults (n = 4155). PRINCIPAL FINDINGS: The survey completion rate was 62%. Seventy-three percent of respondents reported performing at least one administrative task in the past year. About one in three task-doers, or 24.4% of respondents overall, reported delayed or foregone care due to an administrative task: Adjusted for demographics, disability status had the strongest association with administrative tasks (adjusted odds ratio [OR] 2.91, p < 0.001) and burden (adjusted OR 1.66, p < 0.001). Being a woman was associated with doing administrative tasks (adjusted OR 2.19, p < 0.001). Being a college graduate was associated with performing an administrative task (adjusted OR 2.79, p < 0.001), while higher income was associated with fewer subsequent burdens (adjusted OR 0.55, p < 0.01). CONCLUSIONS: Patients frequently do administrative tasks that can create burdens resulting in delayed/foregone care. The prevalence of delayed/foregone care due to administrative tasks is comparable to similar estimates of cost-related barriers to care. Demographic disparities in burden warrant further attention. Enhancing measurement of patient administrative work and associated burdens may identify opportunities for assessing quality, value, and patient experience.

Predictive modeling for trustworthiness and other subjective text properties in online nutrition and health communication.

While the internet has democratized and accelerated content creation and sharing, it has also made people more vulnerable to manipulation and misinformation. Also, the received information can be distorted by psychological biases. This is problematic especially in health-related communications which can greatly affect the quality of life of individuals. We assembled and analyzed 364 texts related to nutrition and health from Finnish online sources, such as news, columns and blogs, and asked non-experts to subjectively evaluate the texts. Texts were rated for their trustworthiness, sentiment, logic, information, clarity, and neutrality properties. We then estimated individual biases and consensus ratings that were used in training regression models. Firstly, we found that trustworthiness was significantly correlated to the information, neutrality and logic of the texts. Secondly, individual ratings for information and logic were significantly biased by the age and diet of the raters. Our best regression models explained up to 70% of the total variance of consensus ratings based on the low-level properties of texts, such as semantic embeddings, presence of key-terms and part-of-speech tags, references, quotes and paragraphs. With a novel combination of crowdsourcing, behavioral analysis, natural language processing and predictive modeling, our study contributes to the automated identification of reliable and high-quality online information. While critical evaluation of truthfulness cannot be surrendered to the machine only, our findings provide new insights into automated evaluation of subjective text properties and analysis of morphologically-rich languages in regards to trustworthiness.

Demand for Health Information on COVID-19 among Vietnamese.

Due to the rapid spread of coronavirus, Vietnam introduced its first national partial lockdown on April 1st, 2020. The public relied on online sources, whether through official websites or phone-based applications, to acquire up-to-date health information, provide accurate instructions, and limit misinformation. This study aims to provide insight regarding the current level of awareness of the pandemic, and to identify associated factors in Vietnamese participants to recommend necessary interventions. A cross-sectional study was conducted using a web-based survey during the first week of the lockdown period. There were 341 observations collected using a snowball sampling technique. A Tobit multivariable regression model was used to identify factors associated with the demand for each category of health information. The most requested information was the latest updated news on the epidemic, followed by information about disease symptoms and updated news on the outbreak. The prevalence of diverse socioeconomic, demographic, and ethnic factors in Vietnam requires consideration of the specific health information needs of unique groups. Identifying group-specific demands would be helpful to provide proper information to fulfill each population group's needs.

The Unhappy Cosmetic Patient: Lessons From Unfavorable Online Reviews of Minimally and Noninvasive Cosmetic Procedures.

BACKGROUND: The number of patients receiving minimally and noninvasive cosmetic procedures is increasing. Often, patients turn to online review forums to gain and share advice regarding cosmetic procedures. Understanding and discussing patient-reported outcome data can help align physician and patient expectations and ultimately help improve the patient experience. OBJECTIVE: To determine the most common reasons patients are dissatisfied with a selection of minimally and noninvasive cosmetic procedures. MATERIALS AND METHODS: Negative patient reviews from the RealSelf.com website were analyzed, and the reason for patient discontent was recorded for the following treatments: tissue stabilized-guided subscision, cryolipolysis, electromagnetic therapy, deoxycholic acid injections, energy-induced thermolysis, radio thermoplasty, threadlifts, and ultrasound therapy. RESULTS: One thousand two hundred four reviews were included in analysis. For all treatments analyzed, the most common reason for patient dissatisfaction was ineffectiveness (n = 782, 65.0%), followed by complications (n = 301, 25.0%). The most common complications were as follows: lumps for tissue stabilized-guided subscision (n = 6, 50.0%), treated area enlargement for cryolipolysis (n = 23, 22.1%), swelling for deoxycholic acid injections (n = 9, 47.4%), numbness for energy-induced thermolysis (n = 6, 35.3%), fat loss for radio thermoplasty (n = 26, 53.1%) and ultrasound therapy (n = 32, 48.5%), and indentations for threadlifts (n = 10, 30.3%). CONCLUSION: Ineffectiveness and complications were the most common reasons for dissatisfaction among all treatments analyzed. Patient-reported outcome data may offer insight into how physicians can improve their patient's satisfaction with cosmetic procedures.

Consumer Health Informatics Adoption among Underserved Populations: Thinking beyond the Digital Divide.

OBJECTIVES: Underserved populations can benefit from consumer health informatics (CHI) that promotes self-management at a lower cost. However, prior literature suggested that the digital divide and low motivation constituted barriers to CHI adoption. Despite increased Internet use, underserved populations continue to show slow CHI uptake. The aim of the paper is to revisit barriers and facilitators that may impact CHI adoption among underserved populations. METHODS: We surveyed the past five years of literature. We searched PubMed for articles published between 2012 and 2017 that describe empirical evaluations involving CHI use by underserved populations. We abstracted and summarized data about facilitators and barriers impacting CHI adoption. RESULTS: From 645 search results, after abstract and full-text screening, 13 publications met the inclusion criteria of identifying barriers to and facilitators of underserved populations' CHI adoption. Contrary to earlier literature, the studies suggested that the motivation to improve health literacy and adopt technology was high among studied populations. Beyond the digital divide, barriers included: low health and computer literacy, challenges in accepting the presented information, poor usability, and unclear content. Factors associated with increased use were: user needs for information, user-access mediated by a proxy person, and early user engagement in system design. CONCLUSIONS: While the digital divide remains a barrier, newer studies show that high motivation for CHI use exists. However, simply gaining access to technology is not sufficient to improve adoption unless CHI technology is tailored to address user needs. Future interventions should consider building larger empirical evidence on identifying CHI barriers and facilitators.

Readability, content analysis, and racial/ethnic diversity of online living kidney donation information.

More than three-fourths of adults in the USA use the Internet to access health-related information. Adults exploring the possibility of living donation should have access to online content that is readable and comprehensive. We simulated a search of online information about living kidney donation and evaluated readability, topics covered, and racial/ethnic diversity of 21 websites meeting inclusion criteria (eg, hosted by a nonprofit or patient advocacy organization, English content, based in USA). Using standard readability metrics, 62% of sites were classified as "Difficult to read" and none achieved the recommended reading level of sixth grade. On average, websites covered 18.5 (62%) of 30 recommended information topics (range: 7 to 28) and only 2.1 (23%) of 9 racial/ethnic diversity items (range: 0 to 6). Overall, the most common nonprofit or patient advocacy organization websites do not meet the readability standards established by the National Institutes of Health and the American Medical Association, many lack fundamental information about living kidney donation, and most are not racially/ethnically diverse. We encourage the transplant community to consider playing a more active role in improving the overall quality of online information disseminated to the general public. Further, there is a need to more critically examine the accuracy of online living donation content in future investigations.