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- PublicationUser-centred Digital Health in Cardiovascular Rehabilitation and Self-management(University College Dublin. School of Computer Science, 2022)
;0000-0003-1330-2406An acute cardiac incident is a life changing event and people face emotional and physical challenges during their transition from hospitalisation to self-management. Supervised rehabilitation programs, like, cardiac rehabilitation play a vital role in supporting this transition. Lack of knowledge, transportation, and motivation limits the uptake of such programs. Increasingly, sensor technologies providing patient-generated data are showing potential to overcome these limitations. But, evidence regarding its routine use and effectiveness is mixed and the commonly reported barriers include insufficient time, data lacking context, unfamiliar structure, misaligned objectives, usability, and reliability issues. Therefore, a greater understanding of patients’ experiences and factors that impact their behaviour after hospitalisation is needed to design such technologies. Also, to increase their success when deployed in real-world clinical contexts, designing by integrating both clinicians' and patients' perspectives is important. User-centred design approaches emphasise the importance of situating user experiences, needs, and preferences as the driver of the digital intervention design. Given the strong evidence from the field of human-computer interaction that user-centred and iterative design methods increase the success of digital health interventions, limited studies were identified that involved users in the design process and applied iterative methods. To contribute new insights to an area lacking in empirical research, this thesis applies the user- centred design methods and the co-design framework to design technology-mediated solutions to support cardiac rehabilitation and self-management. This thesis engages more directly with patients’ and clinicians’ post-hospitalisation experiences and the impact of patient-generated data through a series of studies. Four studies were conducted to achieve the aims of the thesis: a qualitative systematic grounded theory literature review; semi- structured interviews with cardiac patients; co-design study with cardiac rehabilitation clinicians; and field study for system deployment in real-world clinical context. Building on the collective findings of the studies conducted in this thesis, empirically grounded user-centred recommendations are presented to improve the design of technology-mediated support for CR and self-management. The key design recommendations presented in this thesis include: (i) the use of technology to support a normal life, leveraging social influences to extend participants’ sense of normality; (ii) the use of technology to provide both emotional and physical safe zoning; (iii) a focus on recognising capability and providing recommendations that are positive and reinforce this capability; (iv) supplementing objective data from consumer wearable devices with subjective patient experience data to enable meaningful and actionable insights for clinicians; (v) adopting structured approach to subjective data collection grounded in the clinicians’ workflow and co-designed with the clinicians to allow for such data to be shared in a familiar presentation; (vi) the importance of carefully considering the timing, type of App, context, and type of data presentation while sharing data between patients to avoid negative consequences and to empower patients to use technology to self-manage their condition. 48
- PublicationA personalized physical activity coaching app for breast cancer survivors: Design process and early prototype testingBackground: Existing evidence supports the many benefits of physical activity (PA) in breast cancer survival. However, few breast cancer survivors adhere to the recommended levels of activity. A PA coaching app that provides personalized feedback, guidance, and motivation to the user might have the potential to engage these individuals in a more active lifestyle, in line with the general recommendations. To develop a successful tool, it is important to involve the end users in the design process and to make theoretically grounded design decisions. Objective: This study aimed to execute the design process and early prototype evaluation of a personalized PA coaching app for posttreatment breast cancer survivors. In particular, the study explored a design combining behavioral theory and tailored coaching strategies. Methods: The design process was led by a multidisciplinary team, including technical and health professionals, and involved input from a total of 22 survivors. The process comprised 3 stages. In stage 1, the literature was reviewed and 14 patients were interviewed to understand the needs and considerations of the target population toward PA apps. In stage 2, the global use case for the tool was defined, the features were ideated and refined based on theory, and a digital interactive prototype was created. In stage 3, the prototype went through usability testing with 8 patients and was subjected to quality and behavior change potential evaluations by 2 human-computer interaction experts. Results: The design process has led to the conceptualization of a personalized coaching app for walking activities that addresses the needs of breast cancer survivors. The main features of the tool include a training plan and schedule, adaptive goal setting, real-time feedback and motivation during walking sessions, activity status through the day, activity history, weekly summary reports, and activity challenges. The system was designed to measure users’ cadence during walking, use this measure to infer their training zone, and provide real-time coaching to control the intensity of the walking sessions. The outcomes from user testing and expert evaluation of the digital prototype were very positive, with scores from the system usability scale, mobile app rating scale, and app behavior change scale of 95 out of 100, 4.6 out of 5, and 15 out of 21, respectively. Conclusions: Implementing a user-centered design approach for the development and early evaluation of an app brings essential considerations to tailor the solution to the user’s needs and context. In addition, informing the design on behavioral and tailored coaching theories supports the conceptualization of the PA coaching system. This is critical for optimizing the usability, acceptability, and long-term effectiveness of the tool. After successful early in-laboratory testing, the app will be developed and evaluated in a pilot study in a real-world setting.
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