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Evaluating clinicians' user experience and acceptability of LearnTB, a smartphone application for tuberculosis in India.

ABSTRACT: Tuberculosis (TB) is the leading infectious killer, and India accounts for 2.8 of the 10.4 million TB cases that occur each year, making it the highest TB burden country worldwide. Poor quality of TB care is a major driver of the epidemic in India. India's large private, unregulated sector manages over 50% of the TB patients, with studies showing suboptimal diagnosis and treatment in the private sector. Better education of doctors using mobile applications (apps) is a possible solution. While India has seen an explosion of mobile phone services, and while the use of mobile health interventions has been gaining interest, little is known about mHealth around tuberculosis in India.Our study aimed to understand the user experience and acceptability of a smartphone application, LearnTB, amongst private sector academic clinicians in India. This study was conducted amongst 101 clinicians at Kasturba Hospital, Manipal, India. The user experience of participants (part 1) and acceptability (part 2) were evaluated with the use of two valid, English, paper-based questionnaires. The first questionnaire was based on the System Usability Scale (SUS); the second questionnaire was based on the Technology Acceptance Model (TAM). Data were collected during February and March 2017 and were analyzed using descriptive statistics, multiple linear regression as well as logistic regression analysis.A response rate of 99% was achieved; 100 participants responded to the second questionnaire and 100% of the participants responded to the first questionnaire. User experience was very high [mean SUS score =94.4 (92.07-96.76)]. Perceived usefulness (PU) was significantly correlated to intention to use (IU) (r=0.707, P<0.0001), and perceived ease of use (PEU) was significantly correlated to PU (r=0.466, P<0.0001). Path analysis confirmed the direct relationship between PU and IU (0.936, P<0.0001), and the indirect relationship between PEU and IU (0.5102, P<0.0001). Logistic regression analysis helped target items strongly influencing IU, such as "The use of the LearnTB application is compatible with my work habits" [OR =3.20 (1.04-9.84), P=0.004] and "The use of the LearnTB application could promote good clinical practice" [OR =5.23 (1.35-20.29); P=0.016].The first part of the study indicated high user experience of the LearnTB application. The TAM questionnaire (second part) explained a significant portion of the variance in clinicians' IU the LearnTB application. The PU of the application has the highest impact on the clinicians' IU the Learn TB application. This study provides a preliminary analysis of mobile health interventions for tuberculosis in India, and emphasizes the need for future research in this domain.

SUBMITTER: Pande T

PROVIDER: S-EPMC5547173 | biostudies-literature | 2017

REPOSITORIES: biostudies-literature

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Evaluating clinicians' user experience and acceptability of <i>LearnTB</i>, a smartphone application for tuberculosis in India.

Pande Tripti T Saravu Kavitha K Temesgen Zelalem Z Seyoum Al A Rai Shipra S Rao Raghavendra R Mahadev Deekshith D Pai Madhukar M Gagnon Marie-Pierre MP

mHealth 20170727

<h4>Background</h4>Tuberculosis (TB) is the leading infectious killer, and India accounts for 2.8 of the 10.4 million TB cases that occur each year, making it the highest TB burden country worldwide. Poor quality of TB care is a major driver of the epidemic in India. India's large private, unregulated sector manages over 50% of the TB patients, with studies showing suboptimal diagnosis and treatment in the private sector. Better education of doctors using mobile applications (apps) is a possible ...[more]

PMID: 28828377

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Project description:BackgroundTuberculosis affected 2.7 million people in India in 2017. The Revised National TB Control Programme has achieved milestones in coverage, however quality of TB care remains highly variable and often poor, with significant gaps in provider knowledge, practices, and patients consistently lost to follow-up. These quality gaps are largely informed by studies on provider practices or objective chart abstractions and case data. Per the knowledge of the author, no review has been conducted on first-hand patient perspectives on the quality of TB care they receive. This mixed-methods literature review aims to synthesize evidence on user-experience and patient satisfaction with TB care in India and inform areas for service quality improvement.MethodsFive medical databases, including PubMed, EMBASE, Global Health (Ovid), Web of Science, and CINAHL were searched for empirical studies on patient perspectives on TB health services published between January 1st, 2000 to December 31st, 2017. Studies in English with adult patients with any form of TB in the public or private health system were included. Studies prior to entering the health system, on distance to health facilities and cost were excluded. Seven Indian journals were hand searched and a grey literature search was conducted in GoogleScholar. Studies were assessed for methodological quality and thematic analysis was conducted by categorizing data using NVivo 12.ResultsA total of 498 studies were screened, of which 23 met the inclusion criteria. 16 supplementary studies were identified from Indian journals and grey literature. Of the 39 total studies included most were quantitative (29; 74%), based in South India (17; 44%) and focused on drug-sensitive TB patients (19; 49%) within the public health system (25; 64%). Data collection methods were highly heterogenous which limited synthesis and comparisons across population demographics, health sectors, or regions. Overall quantitative patient satisfaction measured in seven studies was high. Two major themes identified were provider-related factors (n = 26 studies) and convenience (n = 25), and six minor themes were supplies and equipment availability (n = 12), confidence (n = 10), information and communication (n = 10), waiting time (n = 8), stigma (n = 4), and confidentiality (n = 4). Each reported positive and negative user-experiences. Most significantly, DOTS did not fit the daily needs and obligations of many patients, particularly due to conflicts with employment and frequency of visits; while positive provider support, information, and flexibility helped patients adhere to treatment.ConclusionAlthough quantitative patient satisfaction was found to be high, data were not collected using robust, validated tools. Qualitative and quantitative user-experiences in each theme were variable, making them both barriers and facilitators of good quality TB care. Poor user-experiences were often responsible for patients interrupting treatment or dropping out of TB care. Patient-centeredness, or user-friendliness of TB care can be improved by introducing individualized or flexible DOTS that is responsive to user circumstances and needs. User-experience data should be systematically collected using a standardized, national tool for identification of specific bottlenecks and successes in quality of TB care from the patients' perspective.

Project description:BackgroundThis project engages patients and physicians in the development of Decision Boxes, short clinical topic summaries covering medical questions that have no single best answer. Decision Boxes aim to prepare the clinician to communicate the risks and benefits of the available options to the patient so they can make an informed decision together.MethodsSeven researchers (including four practicing family physicians) selected 10 clinical topics relevant to primary care practice through a Delphi survey. We then developed two one-page prototypes on two of these topics: prostate cancer screening with the prostate-specific antigen test, and prenatal screening for trisomy 21 with the serum integrated test. We presented the prototypes to purposeful samples of family physicians distributed in two focus groups, and patients distributed in four focus groups. We used the User Experience Honeycomb to explore barriers and facilitators to the communication design used in Decision Boxes. All discussions were transcribed, and three researchers proceeded to thematic content analysis of the transcriptions. The coding scheme was first developed from the Honeycomb's seven themes (valuable, usable, credible, useful, desirable, accessible, and findable), and included new themes suggested by the data. Prototypes were modified in light of our findings.ResultsThree rounds were necessary for a majority of researchers to select 10 clinical topics. Fifteen physicians and 33 patients participated in the focus groups. Following analyses, three sections were added to the Decision Boxes: introduction, patient counseling, and references. The information was spread to two pages to try to make the Decision Boxes less busy and improve users' first impression. To try to improve credibility, we gave more visibility to the research institutions involved in development. A statement on the boxes' purpose and a flow chart representing the shared decision-making process were added with the intent of clarifying the tool's purpose. Information about the risks and benefits according to risk levels was added to the Decision Boxes, to try to ease the adaptation of the information to individual patients.ConclusionResults will guide the development of the eight remaining Decision Boxes. A future study will evaluate the effect of Decision Boxes on the integration of evidence-based and shared decision making principles in clinical practice.

Project description:BackgroundOne of the essential elements of a strategic approach to improving patients' experience is to measure and report on patients' experiences in real time. Real-time feedback (RTF) is increasingly being collected using digital technology; however, there are several factors that may influence the success of the digital system.ObjectiveThe aim of this review was to evaluate the digital maturity and patient acceptability of real-time patient experience feedback systems.MethodsWe systematically searched the following databases to identify papers that used digital systems to collect RTF: The Cochrane Library, Global Health, Health Management Information Consortium, Medical Literature Analysis and Retrieval System Online, EMBASE, PsycINFO, Web of Science, and CINAHL. In addition, Google Scholar and gray literature were utilized. Studies were assessed on their digital maturity using a Digital Maturity Framework on the basis of the following 4 domains: capacity/resource, usage, interoperability, and impact. A total score of 4 indicated the highest level of digital maturity.ResultsRTF was collected primarily using touchscreens, tablets, and Web-based platforms. Implementation of digital systems showed acceptable response rates and generally positive views from patients and staff. Patient demographics according to RTF responses varied. An overrepresentation existed in females with a white predominance and in patients aged ?65 years. Of 13 eligible studies, none had digital systems that were deemed to be of the highest level of maturity. Three studies received a score of 3, 2, and 1, respectively. Four studies scored 0 points. While 7 studies demonstrated capacity/resource, 8 demonstrated impact. None of the studies demonstrated interoperability in their digital systems.ConclusionsPatients and staff alike are willing to engage in RTF delivered using digital technology, thereby disrupting previous paper-based feedback. However, a lack of emphasis on digital maturity may lead to ineffective RTF, thwarting improvement efforts. Therefore, given the potential benefits of RTF, health care services should ensure that their digital systems deliver across the digital maturity continuum.

Project description:BackgroundPolice officers work under stressful conditions, and the resulting occupational stress may impact their health and well-being through changes in positive affect (PA) and negative affect (NA). It is therefore important to assess officers' stress, PA, and NA while it is experienced. This study evaluates police officers' momentary stress and affect in real-world settings using an ecological momentary assessment, and examines the within-person (W) and between-person (B) factors that influence momentary affect.MethodsEighty-nine police officers were recruited in South Korea. Participants completed questionnaires about their momentary stress and affect using a smartphone application. The associations between momentary stress, momentary contextual environment, momentary PA, and momentary NA were examined using mixed modeling.ResultsSocial overload (W: -.37), work discontent (W: -.45, B: -.73), social tension (W: -.79, B: -.67), and pressure to perform (W: -.29, B: -.49) were significantly associated with lower PA. Work overload (B: .33) and social isolation(W: .48, B: .31) were significantly associated with higher PA. Being with family (W: .71, B: .91) and friends (W: 1.89, B: 2.45) were significantly associated with higher PA. Being at home or other places away from the work place were significantly associated with higher PA (W: 1.01) and when patrolling or investigating were associated with lower PA (B: - 1.13). Lack of social recognition (W: 1.74, B: 2.33), work discontent (W: 1.59, B: 1.88), social tension (W: 1.74, B: 2.92), and pressure to perform (W: .78, B: 1.92) were significantly associated with higher NA. Being with colleagues (W: - 1.43), family (W: -1.38, B: - 2.66) and friends (W: -1.78, B: - 2.45) were associated with lower NA.ConclusionsMomentary within-person and between-person stress factors and contextual factors influenced police officers' momentary affect. These factors should be considered when developing interventions to mitigate stress and improve affect in police officers.

Dataset Information

Evaluating clinicians' user experience and acceptability of LearnTB, a smartphone application for tuberculosis in India.

Publications

Evaluating clinicians' user experience and acceptability of <i>LearnTB</i>, a smartphone application for tuberculosis in India.

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