Falls are the leading cause of injury-related mortality and hospitalization among adults aged greater than or equal to 65 years. An important modifiable fall-risk factor is use of fall-risk ...increasing drugs (FRIDs). However, deprescribing is not always attempted or performed successfully. The ADFICE_IT trial evaluates the combined use of a clinical decision support system (CDSS) and a patient portal for optimizing the deprescribing of FRIDs in older fallers. The intervention aims to optimize and enhance shared decision making (SDM) and consequently prevent injurious falls and reduce healthcare-related costs. A multicenter, cluster-randomized controlled trial with process evaluation will be conducted among hospitals in the Netherlands. We aim to include 856 individuals aged greater than or equal to 65 years that visit the falls clinic due to a fall. The intervention comprises the combined use of a CDSS and a patient portal. The CDSS provides guideline-based advice with regard to deprescribing and an individual fall-risk estimation, as calculated by an embedded prediction model. The patient portal provides educational information and a summary of the patient's consultation. Hospitals in the control arm will provide care-as-usual. Fall-calendars will be used for measuring the time to first injurious fall (primary outcome) and secondary fall outcomes during one year. Other measurements will be conducted at baseline, 3, 6, and 12 months and include quality of life, cost-effectiveness, feasibility, and shared decision-making measures. Data will be analyzed according to the intention-to-treat principle. Difference in time to injurious fall between the intervention and control group will be analyzed using multilevel Cox regression. The findings of this study will add valuable insights about how digital health informatics tools that target physicians and older adults can optimize deprescribing and support SDM. We expect the CDSS and patient portal to aid in deprescribing of FRIDs, resulting in a reduction in falls and related injuries.
•This study provides an overview of the use of behavioral theory and UCD in personas-construction for health technology development.•We constructed six personas of a multifactorial falls risk ...assessment tool encompassing external and intrinsic user characteristics.•Personas were highly useful for making decisions about improving the usability and implementation of the tool in practice.•Targeting important external and intrinsic user characteristics that facilitate use and implementation could enhance technology adoption.
Multifactorial falls risk assessment tools (FRATs) can be an effective falls prevention method for older adults, but are often underutilized by health care professionals (HCPs). This study aims to enhance the use and implementation of multifactorial FRATs by combining behavioral theory with the user-centered design (UCD) method of personas construction. Specifically, the study aimed to (1) construct personas that are based on external (i.e., needs, preferences) and intrinsic user characteristics (i.e., behavioral determinants); and (2) use these insights to inform requirements for optimizing an existing Dutch multifactorial FRAT (i.e., the ‘Valanalyse’).
Survey data from HCPs (n = 31) was used to construct personas of the ‘Valanalyse.’ To examine differences between clusters on 68 clustering variables, a multivariate cluster analysis technique with non-parametric analyses and computational methods was used. The aggregated external and intrinsic user characteristics of personas were used to inform key design and implementation requirements for the ‘Valanalyse,’ respectively, whereby intrinsic user characteristics were matched with appropriate behavior change techniques to guide implementation.
Significant differences between clusters were observed in 20 clustering variables (e.g., behavioral beliefs, situations for use). These variables were used to construct six personas representing users of each cluster. Together, the six personas helped operationalize four key design requirements (e.g., guide treatment-related decision making) and 14 implementation strategies (e.g., planning coping responses) for optimizing the ‘Valanalyse’ in Dutch geriatric, primary care settings.
The findings suggest that theory- and evidence-based personas that encompass both external and intrinsic user characteristics are a useful method for understanding how the use and implementation of multifactorial FRATs can be optimized with and for HCPs, providing important implications for developers and eHealth interventions with regards to encouraging technology adoption.
User-oriented problems in healthcare application design are a major threat to intervention effectiveness. Despite recommendations that end-users should be involved in the development of these ...technologies, few studies involve their end-users in systematic and meaningful ways to ensure that applications are customized to their needs and preferences. User-centered design (UCD) involves end-users throughout the development process to ensure that all design aspects and support tasks are easy to operate and of value. This study provides an overview of UCD Methods: to aid researchers in the selection of appropriate methods to improve application design. Additionally, we aim to showcase how end-users can be successfully involved in each stage of the development process.
An overview of UCD Methods: has been developed by (1)using an interdisciplinary theoretical approach, drawing on theories from communication science, health psychology, marketing, and health informatics, (2)identifying specific stages of development in which end-user participation is crucial; and (3)understanding barriers to end-user participation. Best practices of UCD will be discussed.
Each method has its unique value in contributing to UCD; personas can be used to make design decisions, think-a-loud Methods: are valuable in receiving user feedback about which aspects of technology are confusing. Prototypes are useful to gather user requirements at an early stage of the development while how focus groups are fundamental in getting consecutive feedback about these prototypes. Barriers to end-user participation are a cognitive burden and a lack of affinity with technology.
Knowledge about end-user values and needs is essential to create meaningful and effective interventions. Adopting a UCD method will have an immense benefit to end-users as increased usability can have advantages such as reduced stress level, improved accessibility, and reduced threat of damage. This study will help researchers, developers, and designers to create more user-friendly and sustainable healthcare systems.
By preparing and empowering patients prior to a consultation, Patient Portals can be powerful tools to stimulate patient participation in Shared Decision Making (SDM) about falls prevention for older ...adults. However, previous research shows that in developing these portals patients’ needs are often overlooked, problematically leading to ineffective portals. We developed a Patient Portal as part of a multi-component intervention (including a physician component) that takes the end-users’ needs and preferences into account by incorporating User-Centered Design (UCD). The aim of this study is to test the usability of a patient portal that is developed according to the UCD principles.
The Patient Portal was tested through a concurrent think a-loud usability test, a think a-loud questionnaire (i.e. Website Satisfaction Scale) using a scale visually supported by smiley faces, and a semi-structured interview focused on Usability, Content, Navigation, and Comprehensibility (n=6 patients). The final dataset consisted of videotaped screen recordings including mouse movements and clicks, video recordings of the patients, and the interview audio recordings. The occurrence and severity of the usability problems were coded according to Nielsen’s severity rating (0-4).
In total, n=41 usability problems were identified. Most problems related to the Portal’s Usability and Navigation (e.g. the font size was considered to be too small, difficulty locating a navigation button in the menu bar). Problems regarding comprehensibility were also found (e.g. difficult words required an explanation or easier to understand alternative).
Based on the results, the Patient Portal was improved into a ready-to-use portal. Only minor edits were made, possibly because end-users were involved in the development from the start. A Clinical Decision Support System for physicians was simultaneously developed as part of the ADFICE_IT intervention. Next, an RCT with process evaluation will be performed across eight Dutch clinics to study the effects of the intervention.
