Now showing 1 - 3 of 3
  • Publication
    User-centred Digital Health in Cardiovascular Rehabilitation and Self-management
    (University College Dublin. School of Computer Science, 2022) ;
    0000-0003-1330-2406
    An 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.
      283
  • Publication
    A personalized physical activity coaching app for breast cancer survivors: Design process and early prototype testing
    Background: 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.
      330Scopus© Citations 15
  • Publication
    Barriers to and Facilitators of Technology in Cardiac Rehabilitation and Self-Management: Systematic Qualitative Grounded Theory Review
    Background: Dealing with cardiovascular disease is challenging, and people often struggle to follow rehabilitation and self-management programs. Several systematic reviews have explored quantitative evidence on the potential of digital interventions to support cardiac rehabilitation (CR) and self-management. However, although promising, evidence regarding the effectiveness and uptake of existing interventions is mixed. This paper takes a different but complementary approach, focusing on qualitative data related to people’s experiences of technology in this space. Objective: Through a qualitative approach, this review aims to engage more directly with people’s experiences of technology that supports CR and self-management. The primary objective of this paper is to provide answers to the following research question: What are the primary barriers to and facilitators and trends of digital interventions to support CR and self-management? This question is addressed by synthesizing evidence from both medical and computer science literature. Given the strong evidence from the field of human-computer interaction that user-centered and iterative design methods increase the success of digital health interventions, we also assess the degree to which user-centered and iterative methods have been applied in previous work. Methods: A grounded theory literature review of articles from the following major electronic databases was conducted: ACM Digital Library, PsycINFO, Scopus, and PubMed. Papers published in the last 10 years, 2009 to 2019, were considered, and a systematic search with predefined keywords was conducted. Papers were screened against predefined inclusion and exclusion criteria. Comparative and in-depth analysis of the extracted qualitative data was carried out through 3 levels of iterative coding and concept development. Results: A total of 4282 articles were identified in the initial search. After screening, 61 articles remained, which were both qualitative and quantitative studies and met our inclusion criteria for technology use and health condition. Of the 61 articles, 16 qualitative articles were included in the final analysis. Key factors that acted as barriers and facilitators were background knowledge and in-the-moment understanding, personal responsibility and social connectedness, and the need to support engagement while avoiding overburdening people. Although some studies applied user-centered methods, only 6 involved users throughout the design process. There was limited evidence of studies applying iterative approaches. Conclusions: The use of technology is acceptable to many people undergoing CR and self-management. Although background knowledge is an important facilitator, technology should also support greater ongoing and in-the-moment understanding. Connectedness is valuable, but to avoid becoming a barrier, technology must also respect and enable individual responsibility. Personalization and gamification can also act as facilitators of engagement, but care must be taken to avoid overburdening people. Further application of user-centered and iterative methods represents a significant opportunity in this space.
      24Scopus© Citations 28