Change search
Link to record
Permanent link

Direct link
BETA
Publications (10 of 17) Show all publications
Georgsson, M., Staggers, N., Årsand, E. & Kushniruk, A. (2019). Employing a user-centered cognitive walkthrough to evaluate a mHealth diabetes self-management application: A case study and beginning method validation. Journal of Biomedical Informatics, 91, Article ID 103110.
Open this publication in new window or tab >>Employing a user-centered cognitive walkthrough to evaluate a mHealth diabetes self-management application: A case study and beginning method validation
2019 (English)In: Journal of Biomedical Informatics, ISSN 1532-0464, E-ISSN 1532-0480, Vol. 91, article id 103110Article in journal (Refereed) Published
Abstract [en]

Introduction: Self-management of chronic diseases using mobile health (mHealth) systems and applications is becoming common. Current evaluation methods such as formal usability testing can be very costly and time-consuming; others may be more efficient but lack a user focus. We propose an enhanced cognitive walkthrough (CW) method, the user-centered CW (UC-CW), to address identified deficiencies in the original technique and perform a beginning validation with think aloud protocol (TA) to assess its effectiveness, efficiency and user acceptance in a case study with diabetes patient users on a mHealth self-management application. Materials and methods: A total of 12 diabetes patients at University of Utah Health, USA, were divided into UC-CW and think aloud (TA) groups. The UC-CW method included: making the user the main evaluator for detecting usability problems, having a dual domain facilitator, and using three other improved processes: validated task development, higher level tasks and a streamlined evaluation process. Users interacted with the same mHealth application for both methods. Post-evaluation assessments included the NASA RTLX instrument and a set of brief interview questions. Results: Participants had similar demographic characteristics. A total of 26 usability problems were identified with the UC-CW and 20 with TA. Both methods produced similar ratings: severity across all views (UC-CW = 2.7 and TA = 2.6), numbers of problems in the same views (Main View [UC-CW = 11, TA = 10], Carbohydrate Entry View [UC-CW = 4, TA = 3] and List View [UC-CW = 3, TA = 3]) with similar heuristic violations (Match Between the System and Real World [UC-CW = 19, TA = 16], Consistency and Standards [UC-CW = 17, TA = 15], and Recognition Rather than Recall [UC-CW = 13, TA = 10]). Both methods converged on eight usability problems, but the UC-CW group detected five critical issues while the TA group identified two. The UC-CW group identified needed personalized features for patients’ disease needs not identified with TA. UC-CW was more efficient on average time per identified usability problem and on the total evaluation process with patients. NASA RTLX scores indicated that participants experienced the UC-CW half as cognitively demanding. Common themes from interviews indicated the UC-CW as enjoyable and easy to perform while TA was considered somewhat awkward and more cognitively challenging. Conclusions: UC-CW was effective for finding severe, recurring usability problems and it highlighted the need for personalized user features. The method was also efficient and had high user acceptance. These results indicate UC-CW's utility and user acceptance in evaluating a mHealth self-management application. It provides an additional usability evaluation technique for researchers. © 2019

Place, publisher, year, edition, pages
Academic Press Inc., 2019
Keywords
Cognitive walkthrough, Diabetes, Mobile health, Think aloud, Usability, User-centered design, Human computer interaction, Medical problems, mHealth, NASA, Usability engineering, User centered design, Demographic characteristics, Diabetes self-management, Mobile Health (M-Health), Think-aloud protocol, Usability evaluation technique, Heuristic methods
National Category
Endocrinology and Diabetes Other Health Sciences Public Health, Global Health, Social Medicine and Epidemiology
Identifiers
urn:nbn:se:bth-17624 (URN)10.1016/j.jbi.2019.103110 (DOI)2-s2.0-85061136199 (Scopus ID)
Available from: 2019-02-21 Created: 2019-02-21 Last updated: 2019-02-21Bibliographically approved
Georgsson, M. (2018). Toward Patient-centered, Standardized, and Reproducible Approaches of Evaluating the Usability of mHealth Chronic Disease Self-management Systems for Diabetes. (Doctoral dissertation). Karlskrona: Blekinge Tekniska Högskola
Open this publication in new window or tab >>Toward Patient-centered, Standardized, and Reproducible Approaches of Evaluating the Usability of mHealth Chronic Disease Self-management Systems for Diabetes
2018 (English)Doctoral thesis, comprehensive summary (Other academic)
Abstract [en]

Diabetes is a chronic disease affecting 422 million patients worldwide according to World Health Organization data with 30.3 million in the United States and 64 million in Europe. The prevalence speaks to the need for improved ways to support patients in disease self-management. mHealth solutions are increasingly used for this; however, usability is a current challenge affecting patients’ mHealth use. Recent literature emphasizes an increased focus on patient-centeredness in diabetes care, user-centeredness in chronic disease mHealth system design and standardized, systematic approaches for usability evaluation. The aim of this thesis and its individual studies was to incorporate these foci into the evaluation of two mobile health self-management systems for diabetes.

Study I used ISO standard 9241-11 to examine the relationship between selected group characteristics of diabetes patients on specific interaction outcomes to quantitatively identify needed system modifications. Study II utilized a multi-method design to assess diabetes patients’ mHealth usage and combined two novel analytic methods to structure and analyze results. Study III used a modified, user-oriented heuristic evaluation (HE) method, validated tasks and in-depth severity factor ratings to identify critical problems from patients’ point of view. By developing and employing a modified, user-centered cognitive walkthrough method (UC-CW), study IV assessed its effectiveness and efficiency in finding relevant usability problems for users as well as patients’ acceptance. The modified CW was validated against the golden-standard user test with Think Aloud.

Study I emphasized the importance of considering user characteristics in mHealth performance as these influenced interaction outcomes. All patients had difficulties with multiple-step tasks. Patients more recently diagnosed were able to perform tasks more successfully, with fewer errors and at faster times and had higher satisfaction scores; similar outcomes to the more experienced users. Educational level did not, however, seem to influence performance. In study II, the usability test with Think-Aloud (TA), in-depth interviews and questionnaires contributed to 19 consolidated issues, and triangulated on 5 critical usability problems for users. The combined analysis methods resulted in structured, categorized descriptions to aid in problem-solving. In Study III, the disease-related, critical information deficiencies found by expert evaluators using the modified, structured method also converged on and highlighted potentially adverse user concerns. Study IV demonstrated that the UC-CW found more critical user problems compared to the user test with TA despite both methods producing similar major average severity ratings and violations of heuristic categories. The modified method was more efficient per detected problem and experienced as less cognitively demanding and with a higher ease of use.

These studies offer different approaches that include patient-centered, efficient and user-acceptable methods and method modifications to detect critical usability issues for users. Importantly, improved mHealth designs for users could mean improvement in interactions, interaction performance, increased adoption, and long-term perhaps even increased adherence to interventions for chronic conditions.

Place, publisher, year, edition, pages
Karlskrona: Blekinge Tekniska Högskola, 2018. p. 165
Series
Blekinge Institute of Technology Doctoral Dissertation Series, ISSN 1653-2090 ; 03
Keywords
Chronic Disease, Diabetes, Mobile Health, mHealth, Self-management, Usability Evaluation, User-centered Design
National Category
Computer Sciences
Identifiers
urn:nbn:se:bth-15140 (URN)978-91-7295-349-9 (ISBN)
Public defence
2018-02-23, J1650, BTH, Valhallavägen 1, 37179, Karlskrona, 09:30 (Swedish)
Opponent
Supervisors
Note

Tillämpad Hälsoteknik

Applied Health Technology

Available from: 2018-01-29 Created: 2018-01-26 Last updated: 2018-04-06Bibliographically approved
Georgsson, M. (2018). Using activity theory as a framework for the usability evaluation process and task determination in mhealth self-management systems for diabetes. In: Studies in Health Technology and Informatics: . Paper presented at 15th International Conference on Wearable Micro and Nano Technologies for Personalized Health, pHealth 2018; Gjovik; Norway (pp. 158-163). IOS Press, 249
Open this publication in new window or tab >>Using activity theory as a framework for the usability evaluation process and task determination in mhealth self-management systems for diabetes
2018 (English)In: Studies in Health Technology and Informatics, IOS Press , 2018, Vol. 249, p. 158-163Conference paper, Published paper (Refereed)
Abstract [en]

mHealth systems can be used for patients in their diabetes selfmanagement, but usability evaluations are often needed to determine how to make them more useful for the diabetes patient user in the monitoring and managing of their disease. Activity Theory (AT) was developed within Russian psychology to define the work and activity process in an activity system. AT was here considered to also be a particularly suitable framework for inspiration in usability evaluation both for the whole evaluation process and also for the usability task determination in this process for diabetes patient users. In the following paper, examples are provided from four usability studies using both user-based and expert usability methods in evaluation showing how AT was applied to guide the thoughts in evaluating the usability of two mHealth self-management systems for diabetes. Experiences and insights are provided from this process. © 2018 The authors and IOS Press. All rights reserved.

Place, publisher, year, edition, pages
IOS Press, 2018
Series
Studies in Health Technology and Informatics, ISSN 0926-9630
Keywords
Activity Theory, Diabetes, Mobile Health, Usability Evaluation
National Category
Endocrinology and Diabetes Other Medical Sciences not elsewhere specified
Identifiers
urn:nbn:se:bth-16796 (URN)10.3233/978-1-61499-868-6-158 (DOI)2-s2.0-85049009137 (Scopus ID)9781614998679 (ISBN)
Conference
15th International Conference on Wearable Micro and Nano Technologies for Personalized Health, pHealth 2018; Gjovik; Norway
Available from: 2018-07-12 Created: 2018-07-12 Last updated: 2018-07-12Bibliographically approved
Roberts, K., Boland, M. R., Pruinelli, L., Dcruz, J., Berry, A., Georgsson, M., . . . Brennan, P. F. (2017). Biomedical informatics advancing the national health agenda: the AMIA 2015 year-in-review in clinical and consumer informatics.. JAMIA Journal of the American Medical Informatics Association, E1, E185-E190
Open this publication in new window or tab >>Biomedical informatics advancing the national health agenda: the AMIA 2015 year-in-review in clinical and consumer informatics.
Show others...
2017 (English)In: JAMIA Journal of the American Medical Informatics Association, ISSN 1067-5027, E-ISSN 1527-974X, Vol. E1, p. E185-E190Article in journal (Refereed) Published
Abstract [en]

The field of biomedical informatics experienced a productive 2015 in terms of research. In order to highlight the accomplishments of that research, elicit trends, and identify shortcomings at a macro level, a 19-person team conducted an extensive review of the literature in clinical and consumer informatics. The result of this process included a year-in-review presentation at the American Medical Informatics Association Annual Symposium and a written report (see supplemental data). Key findings are detailed in the report and summarized here. This article organizes the clinical and consumer health informatics research from 2015 under 3 themes: the electronic health record (EHR), the learning health system (LHS), and consumer engagement. Key findings include the following: (1) There are significant advances in establishing policies for EHR feature implementation, but increased interoperability is necessary for these to gain traction. (2) Decision support systems improve practice behaviors, but evidence of their impact on clinical outcomes is still lacking. (3) Progress in natural language processing (NLP) suggests that we are approaching but have not yet achieved truly interactive NLP systems. (4) Prediction models are becoming more robust but remain hampered by the lack of interoperable clinical data records. (5) Consumers can and will use mobile applications for improved engagement, yet EHR integration remains elusive.

Place, publisher, year, edition, pages
Oxford University Press, 2017
Keywords
biomedical informatics; year in review; electronic health records; learning health system; consumer engagement
National Category
Other Computer and Information Science
Identifiers
urn:nbn:se:bth-13244 (URN)10.1093/jamia/ocw103 (DOI)000397030400026 ()27497798 (PubMedID)
Available from: 2016-10-11 Created: 2016-10-11 Last updated: 2018-01-14Bibliographically approved
Georgsson, M. & Staggers, N. (2017). Patients' Perceptions and Experiences of a mHealth Diabetes Self-management System. Computers, Informatics, Nursing, 35(3), 122-130
Open this publication in new window or tab >>Patients' Perceptions and Experiences of a mHealth Diabetes Self-management System
2017 (English)In: Computers, Informatics, Nursing, ISSN 1538-2931, E-ISSN 1538-9774, Vol. 35, no 3, p. 122-130Article in journal (Refereed) Published
Abstract [en]

Chronic diseases, including diabetes, constitute a substantial disease burden around the world. Mobile self-management systems now play a significant and increasingly important role in patients' disease management. Yet, patients' perceptions of these systems after longer-term use are largely unexplored. A random sample of 10 diabetes patients was assessed immediately after they exited a larger, 6-month randomized controlled trial on the use of a mHealth system called Care4Life. This descriptive, exploratory study assessed patients' perceptions and experiences of mHealth using a questionnaire and semistructured interview whose development was guided by the Technology Acceptance Model. Results indicated that patients saw clear benefits in using the technology and had favorable behavioral disease outcomes after using Care4Life. Suggestions for improving the system were highly individual despite the apparent homogeneity of the patient group. The study begins to fill the gap about the longer-term use of mHealth systems in chronic disease management and reflects the significance of individual needs for mHealth systems.

Place, publisher, year, edition, pages
LIPPINCOTT WILLIAMS & WILKINS, 2017
Keywords
Diabetes, Mobile health, Patient experiences, Patient perceptions, Self-management
National Category
Nursing
Identifiers
urn:nbn:se:bth-14104 (URN)000396210700003 ()27748662 (PubMedID)
Available from: 2017-04-18 Created: 2017-04-18 Last updated: 2017-04-19Bibliographically approved
Georgsson, M. (2016). A Modified User-Oriented Heuristic Evaluation of a Mobile Health System for Diabetes Self-management Support. Computers, Informatics, Nursing, 34(2), 77-84
Open this publication in new window or tab >>A Modified User-Oriented Heuristic Evaluation of a Mobile Health System for Diabetes Self-management Support
2016 (English)In: Computers, Informatics, Nursing, ISSN 1538-2931, E-ISSN 1538-9774, Vol. 34, no 2, p. 77-84Article in journal (Refereed) Published
Abstract [en]

Mobile health platforms offer significant opportunities for improving diabetic self-care, but only if adequate usability exists. Expert evaluations such as heuristic evaluation can provide distinct usability information about systems. The purpose of this study was to complete a usability evaluation of a mobile health system for diabetes patients using a modified heuristic evaluation technique of (1) dual-domain experts (healthcare professionals, usability experts), (2) validated scenarios and user tasks related to patients' self-care, and (3) in-depth severity factor ratings. Experts identified 129 usability problems with 274 heuristic violations for the system. The categories Consistency and Standards dominated at 24.1% (n = 66), followed by Match Between System and Real World at 22.3% (n = 61). Average severity ratings across system views were 2.8 (of 4), with 9.3% (n = 12) rated as catastrophic and 53.5% (n = 69) as major. The large volume of violations with severe ratings indicated clear priorities for redesign. The modified heuristic approach allowed evaluators to identify unique and important issues, including ones related to self-management and patient safety. This article provides a template for one type of expert evaluation adding to the informaticists' toolbox when needing to conduct a fast, resource-efficient and user-oriented heuristic evaluation. 

Place, publisher, year, edition, pages
Lippincott Williams & Wilkins, 2016
Keywords
Diabetes; Heuristic evaluation; Mobile health; Patient self-management; Usability evaluation
National Category
Endocrinology and Diabetes
Identifiers
urn:nbn:se:bth-11380 (URN)10.1097/CIN.0000000000000209 (DOI)000376461500004 ()
Note

Open access

Available from: 2016-01-08 Created: 2016-01-08 Last updated: 2018-01-26Bibliographically approved
Topaz, M., Ronquillo, C., Peltonen, L.-M., Pruinelli, L., Sarmiento, R., Badger, M., . . . Alhuwail, D. (2016). Advancing nursing informatics in the next decade: Recommendations from an international survey. In: Studies in Health Technology and Informatics: . Paper presented at 13th International Conference on Nursing Informatics, NI 2016; Geneva (pp. 123-127). IOS Press, 225
Open this publication in new window or tab >>Advancing nursing informatics in the next decade: Recommendations from an international survey
Show others...
2016 (English)In: Studies in Health Technology and Informatics, IOS Press, 2016, Vol. 225, p. 123-127Conference paper, Published paper (Refereed)
Abstract [en]

In the summer of 2015, the International Medical Informatics Association Nursing Informatics Special Interest Group (IMIA NISIG) Student Working Group developed and distributed an international survey of current and future trends in nursing informatics. The survey was developed based on current literature on nursing informatics trends and translated into six languages. Respondents were from 31 different countries in Asia, Africa, North and Central America, South America, Europe, and Australia. This paper presents the results of responses to the survey question: "What should be done (at a country or organizational level) to advance nursing informatics in the next 5-10 years?" (n responders=272). Using thematic qualitative analysis, responses were grouped into five key themes: 1) Education and training; 2) Research; 3) Practice; 4) Visibility; and 5) Collaboration and integration. We also provide actionable recommendations for advancing nursing informatics in the next decade. © 2016 IMIA and IOS Press.

Place, publisher, year, edition, pages
IOS Press, 2016
Series
Studies in Health Technology and Informatics, ISSN 0926-9630 ; 225
Keywords
Africa; Asia; Australia; Central America; education; Europe; human; human experiment; nomenclature; nursing informatics; qualitative analysis; South America; visibility
National Category
Nursing Human Computer Interaction
Identifiers
urn:nbn:se:bth-13203 (URN)10.3233/978-1-61499-658-3-123 (DOI)000385238600025 ()2-s2.0-84978719083 (Scopus ID)9781614996576 (ISBN)
Conference
13th International Conference on Nursing Informatics, NI 2016; Geneva
Note

Conference of 13th International Conference on Nursing Informatics, NI 2016 ; Conference Date: 25 June 2016 Through 29 June 2016; Conference Code:122431

Available from: 2016-10-03 Created: 2016-10-03 Last updated: 2018-01-14Bibliographically approved
Georgsson, M. & Nancy, S. (2016). An evaluation of patients' experienced usability of a diabetes mHealth system using a multi-method approach. Journal of Biomedical Informatics, 59, 115-129
Open this publication in new window or tab >>An evaluation of patients' experienced usability of a diabetes mHealth system using a multi-method approach
2016 (English)In: Journal of Biomedical Informatics, ISSN 1532-0464, E-ISSN 1532-0480, Vol. 59, p. 115-129Article in journal (Refereed) Published
Place, publisher, year, edition, pages
Elsevier, 2016
Keywords
Diabetes; Framework analysis; Multi-method evaluation; Usability Problem Taxonomy; mHealth
National Category
Endocrinology and Diabetes
Identifiers
urn:nbn:se:bth-11379 (URN)10.1016/j.jbi.2015.11.008 (DOI)000384703900009 ()
Note

open access

Available from: 2016-01-08 Created: 2016-01-08 Last updated: 2018-01-26Bibliographically approved
Peltonen, L.-M., Alhuwail, D., Ali, S., Badger, M., Eler, G., Georgsson, M., . . . Topaz, M. (2016). Current trends in nursing informatics: Results of an international survey. In: Sermeus W.,Weber P.,Procter P.M. (Ed.), Studies in Health Technology and Informatics: . Paper presented at 13th International Conference on Nursing Informatics, NI 2016; Geneva (pp. 938-939). IOS Press, 225
Open this publication in new window or tab >>Current trends in nursing informatics: Results of an international survey
Show others...
2016 (English)In: Studies in Health Technology and Informatics / [ed] Sermeus W.,Weber P.,Procter P.M., IOS Press, 2016, Vol. 225, p. 938-939Conference paper, Published paper (Refereed)
Abstract [en]

Nursing informatics (NI) can help provide effective and safe healthcare. This study aimed to describe current research trends in NI. In the summer 2015, the IMIA-NI Students Working Group created and distributed an online international survey of the current NI trends. A total of 402 responses were submitted from 44 countries. We identified a top five NI research areas: standardized terminologies, mobile health, clinical decision support, patient safety and big data research. NI research funding was considered to be difficult to acquire by the respondents. Overall, current NI research on education, clinical practice, administration and theory is still scarce, with theory being the least common. Further research is needed to explain the impact of these trends and the needs from clinical practice. © 2016 IMIA and IOS Press.

Place, publisher, year, edition, pages
IOS Press, 2016
Series
Studies in Health Technology and Informatics, ISSN 0926-9630 ; 225
Keywords
clinical practice; decision support system; education; funding; human; human experiment; nomenclature; nursing informatics; patient safety; research priority; student; summer
National Category
Nursing Other Computer and Information Science
Identifiers
urn:nbn:se:bth-13179 (URN)10.3233/978-1-61499-658-3-938 (DOI)000385238600260 ()2-s2.0-84978765782 (Scopus ID)9781614996576 (ISBN)
Conference
13th International Conference on Nursing Informatics, NI 2016; Geneva
Note

Conference of 13th International Conference on Nursing Informatics, NI 2016 ; Conference Date: 25 June 2016 Through 29 June 2016; Conference Code:122431

Available from: 2016-10-04 Created: 2016-10-03 Last updated: 2018-01-14Bibliographically approved
Georgsson, M. & Staggers, N. (2016). Heuristic evaluation of a mhealth diabetes self-management system using disease specific patient profiles. In: Studies in Health Technology and Informatics: . Paper presented at 13th International Conference on Nursing Informatics, NI 2016; Geneva (pp. 530-534). IOS Press, 225
Open this publication in new window or tab >>Heuristic evaluation of a mhealth diabetes self-management system using disease specific patient profiles
2016 (English)In: Studies in Health Technology and Informatics, IOS Press, 2016, Vol. 225, p. 530-534Conference paper, Published paper (Refereed)
Abstract [en]

Patient-centeredness is an important concept in diabetes treatment. We modified Nielsen’s expert heuristic evaluation method addressing common gaps: a patient perspective and variability in findings. Two expert, dual-domain evaluators referred to validated patient profiles (mild, moderate, severe diabetes) when conducting uniform evaluation processes on a diabetes mHealth system. Evaluators found 103 usability problems and 224 heuristic violations. For 69 % of the problems, the profiles had an effect on severity ratings. "Consistency and Standards" (n=57) and "Match between the System and Real World" (n=55) violations dominated at 50%. The overall system severity rating was major. Severity was highest for a severe diabetic profile due to likely visual issues (crowded elements), cognitive concerns (remembering many steps) and for insufficient medication information. Interrater reliability was respectable at Kappa =0.67. Our novel evaluation method represents one way of improving on a usability expert technique making it more patient-centered with less individual evaluator variability. © 2016 IMIA and IOS Press.

Place, publisher, year, edition, pages
IOS Press, 2016
Series
Studies in Health Technology and Informatics, ISSN 0926-9630 ; 225
Keywords
Diabetes; Heuristic evaluation; mHealth; Patient-centered evaluation; Usability; User-centered design
National Category
Nursing Human Computer Interaction
Identifiers
urn:nbn:se:bth-13200 (URN)10.3233/978-1-61499-658-3-530 (DOI)000385238600106 ()2-s2.0-84978768155 (Scopus ID)978-1-61499-658-3 (ISBN)
Conference
13th International Conference on Nursing Informatics, NI 2016; Geneva
Note

Conference of 13th International Conference on Nursing Informatics, NI 2016 ; Conference Date: 25 June 2016 Through 29 June 2016; Conference Code:122431

Available from: 2016-10-03 Created: 2016-10-03 Last updated: 2018-01-14Bibliographically approved
Organisations
Identifiers
ORCID iD: ORCID iD iconorcid.org/0000-0002-9854-7690

Search in DiVA

Show all publications