Applying User-Centered Design Methods to the Development of an mHealth Application for Use in the Hospital Setting by Patients and Care Partners

Abstract

Introduction Developing an optimized and user-friendly mHealth application for patients and family members in the hospital environment presents unique challenges given the diverse patient population and patients' various states of well-being.

Objective This article describes user-centered design methods and results for developing the patient and family facing user interface and functionality of MySafeCare, a safety reporting tool for hospitalized patients and their family members.

Methods Individual and group usability sessions were conducted with specific testing scenarios for participants to follow to test the usability and functionality of the tool. Participants included patients, family members, and Patient and Family Advisory Council (PFAC) members. Engagement rounds were also conducted on study units and lessons learned provided additional information to the usability work. Usability results were aligned with Nielsen's Usability Heuristics.

Results Eleven patients and family members and 25 PFAC members participated in usability testing and over 250 patients and family members were engaged during research team rounding. Specific themes resulting from the usability testing sessions influenced the changes made to the user interface design, workflow functionality, and terminology.

Conclusion User-centered design should focus on workflow functionality, terminology, and user interface issues for mHealth applications. These themes illustrated issues aligned with four of Nielsen's Usability Heuristics: match between system and the real world, consistency and standards, flexibility and efficiency of use, and aesthetic and minimalist design. We identified workflow and terminology issues that may be specific to the use of an mHealth application focused on safety and used by hospitalized patients and their families.

Keywords

user-centered design - patient safety - patient- and family-centered care - mHealth

Protection of Human and Animal Subjects

This study was reviewed by and performed in compliance with the Institutional Review Board.

• References

• 1 Majmudar MD, Colucci LA, Landman AB. The quantified patient of the future: Opportunities and challenges. Healthc (Amst) 2015; 3 (03) 153-156
• 2 Prey JE, Woollen J, Wilcox L. , et al. Patient engagement in the inpatient setting: a systematic review. J Am Med Inform Assoc 2014; 21 (04) 742-750
• 3 Goggins KM, Wallston KA, Nwosu S, Schildcrout JS, Castel L, Kripalani S. ; Vanderbilt Inpatient Cohort Study (VICS). Health literacy, numeracy, and other characteristics associated with hospitalized patients' preferences for involvement in decision making. J Health Commun 2014; 19 (Suppl. 02) 29-43
• 4 Shankar KN, Hirschman KB, Hanlon AL, Naylor MD. Burden in caregivers of cognitively impaired elderly adults at time of hospitalization: a cross-sectional analysis. J Am Geriatr Soc 2014; 62 (02) 276-284
• 5 Schneider EC, Ridgely MS, Quigley DD. , et al. Developing and Testing the Health Care Safety Hotline: A Prototype Consumer Reporting System for Patient Safety Events. Final Report (Prepared by RAND Corporation under Contract HHSA2902010000171). Rockville, MD; 2016
• 6 Lawton R, O'Hara JK, Sheard L. , et al. Can patient involvement improve patient safety? A cluster randomised control trial of the Patient Reporting and Action for a Safe Environment (PRASE) intervention. BMJ Qual Saf 2017; 26 (08) 622-631
• 7 Andresen M, Guic E, Orellana A, Diaz MJ, Castro R. Posttraumatic stress disorder symptoms in close relatives of intensive care unit patients: Prevalence data resemble that of earthquake survivors in Chile. J Crit Care 2015; 30 (05) 1152.e7-1152.e11
• 8 Lloyd RB, Rosenthal LJ. Acute traumatic and depressive symptoms in family members of hospitalized individuals with delirium. Int J Psychiatry Med 2015; 50 (02) 191-202
• 9 Bužgová R, Kozáková R, Sikorová L. Assessment of quality of life of family members of inpatients with end-stage disease. J Palliat Care 2015; 31 (04) 250-257
• 10 Dykes P, Stade D, Chang F. , et al. Participatory Design and Development of a Patient-centered Toolkit to Engage Hospitalized Patients and Care Partners in their Plan of Care. AMIA Annual Symposium Proceedings; 2014
• 11 Fidopiastis CM, Rizzo AA, Rolland JP. User-centered virtual environment design for virtual rehabilitation. J Neuroeng Rehabil 2010; 7: 11
• 12 Taha J, Sharit J, Czaja SJ. The impact of numeracy ability and technology skills on older adults' performance of health management tasks using a patient portal. J Appl Gerontol 2014; 33 (04) 416-436
• 13 Sarkar U, Karter AJ, Liu JY. , et al. The literacy divide: health literacy and the use of an internet-based patient portal in an integrated health system-results from the diabetes study of northern California (DISTANCE). J Health Commun 2010; 15 (Suppl. 02) 183-196
• 14 Weingart SN, Pagovich O, Sands DZ. , et al. What can hospitalized patients tell us about adverse events? Learning from patient-reported incidents. J Gen Intern Med 2005; 20 (09) 830-836
• 15 Hincapie AL, Slack M, Malone DC, MacKinnon NJ, Warholak TL. Relationship Between patients' perceptions of care quality and health care errors in 11 countries: a secondary data analysis. Qual Manag Health Care 2016; 25 (01) 13-21
• 16 Couture B, Cleveland J, Ergia A. , et al. User-Centered Design of the Clinical Dashboard for the MySafeCare Patient Safety Reporting System. AMIA Annual Symposium Proceedings; 2015:1. Available at: https://knowledge.amia.org/59310-amia-1.2741865/t005-1.2744350/f005-1.2744351/2247185-1.2745295/2247185-1.2745296?timeStamp=1457468408316 . Accessed March 8, 2016
• 17 Weingart SN, Pagovich O, Sands DZ. , et al. Patient-reported service quality on a medicine unit. Int J Qual Health Care 2006; 18 (02) 95-101
• 18 Currie LM, Desjardins KS, Levine ES. , et al. Web-based hazard and near-miss reporting as part of a patient safety curriculum. J Nurs Educ 2009; 48 (12) 669-677
• 19 Weissman JS, Schneider EC, Weingart SN. , et al. Comparing patient-reported hospital adverse events with medical record review: do patients know something that hospitals do not?. Ann Intern Med 2008; 149 (02) 100-108
• 20 Nielsen J. Heuristic evaluation. In Nielsen J, Mack RL. (Eds.), Usability Inspection Methods, New York, NY: John Wiley & Sons; 1994. b
• 21 Apple Inc. Apple Research Kit. Available at: http://www.apple.com/researchkit/ . Accessed March 8, 2016
• 22 Dalal AK, Dykes PC, Collins S. , et al. A web-based, patient-centered toolkit to engage patients and caregivers in the acute care setting: a preliminary evaluation. J Am Med Inform Assoc 2016; 23 (01) 80-87
• 23 Dykes P, Stade D, Chang F. , et al. Participatory Design and Development of a Patient-centered Toolkit to Engage Hospitalized Patients and Care Partners in their Plan of Care. Proceedings of the American Medical Informatics Association Annual Fall Symposium; November 16–19, 2014 . Washington, DC