Jobke Wentzel

Mixing Online and Face-to-Face Therapy: How to Benefit From Blended Care in Mental Health Care

Blended care, a combination of online and face-to-face therapy, is increasingly being applied in mental health care to obtain optimal benefit from the advantages these two treatment modalities have. Promising results have been reported, but a variety in descriptions and ways of operationalizing blended care exists. Currently, what type of “blend” works for whom, and why, is unclear. Furthermore, a rationale for setting up blended care is often lacking. In this viewpoint paper, we describe postulates for blended care and provide an instrument (Fit for Blended Care) that aims to assist therapists and patients whether and how to set up blended care treatment. A review of the literature, two focus groups (n=5 and n=5), interviews with therapists (n=14), and interviews with clients (n=2) were conducted to develop postulates of eHealth and blended care and an instrument to assist therapists and clients in setting up optimal blended care. Important postulates for blended care are the notion that both treatment modalities should complement each other and that set up of blended treatment should be based on shared decision making between patient and therapist. The “Fit for Blended Care” instrument is presented which addresses the following relevant themes: possible barriers to receiving blended treatment such as the risk of crisis, issues in communication (at a distance), as well as possible facilitators such as social support. More research into the reasons why and for whom blended care works is needed. To benefit from blended care, face-to-face and online care should be combined in such way that the potentials of both treatment modalities are used optimally, depending on patient abilities, needs, and preferences. To facilitate the process of setting up a personalized blended treatment, the Fit for Blended Care instrument can be used. By applying this approach in research and practice, more insight into the working mechanisms and optimal (personal) “blends” of online and face-to-face therapy becomes within reach.

Participatory eHealth development to support nurses in antimicrobial stewardship

BackgroundAntimicrobial resistance poses a threat to patient safety worldwide. To stop antimicrobial resistance, Antimicrobial Stewardship Programs (ASPs; programs for optimizing antimicrobial use), need to be implemented. Within these programs, nurses are important actors, as they put antimicrobial treatment into effect. To optimally support nurses in ASPs, they should have access to information that supports them in their preparation, administration and monitoring tasks. In addition, it should help them to detect possible risks or adverse events associated with antimicrobial therapy. In this formative study, we investigate how nurses’ can be supported in ASPs by means of an eHealth intervention that targets their information needs.MethodsWe applied a participatory development approach that involves iterative cycles in which health care workers, mostly nurses, participate. Focus groups, observations, prototype evaluations (via a card sort task and a scenario-based information searching task) and interviews are done with stakeholders (nurses, managers, pharmacist, and microbiologist) on two pulmonary wards of a 1000-bed teaching hospital.ResultsTo perform the complex antimicrobial-related tasks well, nurses need to consult various information sources on a myriad of occasions. In addition, the current information infrastructure is unsupportive of ASP-related tasks, mainly because information is not structured to match nurse tasks, is hard to find, out of date, and insufficiently supportive of awareness. Based our findings, we created a concept for a nurse information application. We attuned the application’s functionality, content, and structure to nurse work practice and tasks.ConclusionsBy applying a participatory development approach, we showed that task support is a basic need for nurses. Participatory development proved useful regarding several aspects. First, it allows for combining bottom-up needs (nurses’) and top-down legislations (medical protocols). Second, it enabled us to fragmentise and analyse tasks and to reduce and translate extensive information into task-oriented content. Third, this facilitated a tailored application to support awareness and enhance patient safety. Finally, the involvement of stakeholders created commitment and ownership, and helped to weigh needs from multiple perspectives.

Developing requirements for a mobile app to support citizens in dealing with ticks and tick bites via end-user profiling

Tick bites and tick-borne infections are an increasingly large problem. There is a wide range of precautions that citizens can take, but compliance is low. Mobile technology can offer a solution here, as they allow citizens to access health information in context. In this article, we discuss the development of requirements for a mobile app to support citizens in dealing with ticks and tick bites. First, we identified organizational stakeholders based on relevant protocols, and primary end-users via a systematic risk determination procedure. Then, we profiled end-users based on 25 in-depth interviews. We consulted organizational stakeholders via a focus group. The mobile app should primarily motivate citizens to check themselves for tick bites after visiting a risk area. The app should also include a tick radar, alerts to remind people to check for tick bites, and the possibility to document tick bites. Our experiences underline the necessity of thoroughly investigating the designated end-users and their context of use in order to tailor preventive health advice, and we demonstrate how this can be done. Finally, this case shows the need to create persuasive health technology in order to maximize citizen compliance.

Antibiotic information application offers nurses quick support

BACKGROUND Nurses can be crucial contributors to antibiotic stewardship programs (ASPs), interventions aimed at improving antibiotic use, but nurse empowerment in ASPs adds to their job complexity. Nurses work in complex settings with high cognitive loads, which ask for easily accessible information. An information application (app) was developed to support nurses in ASPs. The efficiency, effectiveness, and user satisfaction regarding this antibiotic app were tested in a pilot study. METHODS The app was introduced into 2 lung wards of a local teaching hospital. During the 8-month pilot study, the 62 nurses of the wards had access to the app. Changes in user satisfaction regarding information support, safety attitudes, and ASP behavior were assessed with a questionnaire. At baseline, 28 nurses completed the (e-mail) questionnaire; after the study, 18 nurses participated. Scenario-based tests were done to assess app efficiency and effectiveness at baseline (n = 16) and in a randomized control (without the app, n = 17) and intervention condition (with the app, n = 17). RESULTS Significant improvements were found regarding task support (P = .041), reliability (P = .004), unobtrusiveness (P = .000), relevance (P = .002), user friendliness (P = .000), speed, and hyperlinks (P = .001). An improvement in communication was observed regarding nurse-physician understanding (P = .034). With the app, nurses solved the scenarios faster than without it. CONCLUSIONS The human-centered design approach and persuasive strategy of task support were effective in reducing time needed to find information. Stewardship-related behaviors need active education strategies.

The value of participatory development to support antimicrobial stewardship with a clinical decision support system

HighlightsCurrent Clinical Decision Support Systems for ASP are guideline‐ or expert‐driven.A participatory development process improves their fit with clinical practice.Scenario‐based prototype evaluations with end‐users give insight in their needs.Involving multiple stakeholders can provide insight in unrecognized needs.Support for selection of diagnostic tests is such unrecognized but relevant need. Background: Current clinical decision support systems (CDSSs) for antimicrobial stewardship programs (ASPs) are guideline‐ or expert‐driven. They are focused on (clinical) content, not on supporting real‐time workflow. Thus, CDSSs fail to optimally support prudent antimicrobial prescribing in daily practice. Our aim was to demonstrate why and how participatory development (involving end‐users and other stakeholders) can contribute to the success of CDSSs in ASPs. Methods: A mixed‐methods approach was applied, combining scenario‐based prototype evaluations (to support verbalization of work processes and out‐of‐the‐box thinking) among 6 medical resident physicians with an online questionnaire (to cross‐reference findings of the prototype evaluations) among 54 Dutch physicians. Results: The prototype evaluations resulted in insight into the end‐users and their way of working, as well as their needs and expectations. The online questionnaire that was distributed among a larger group of medical specialists, including lung and infection experts, complemented the findings of the prototype evaluations. It revealed a say/do problem concerning the unrecognized need of support for selecting diagnostic tests. Conclusions: Low‐fidelity prototypes of a technology allow researchers to get to know the end‐users, their way of working, and their work context. Involving experts allows technology developers to continuously check the fit between technology and clinical practice. The combination enables the participatory development of technology to successfully support ASPs.

Wearables for all: development of guidelines to stimulate accessible wearable technology design

In this paper, we present the rationale and approach for establishing guidelines for the development of accessible wearables. Wearable technology is increasingly integrated in our everyday lives. Therefore, ensuring accessibility is pivotal to prevent a digital divide between persons who have and persons who lack access to these devices, caused by their abilities. We present a project in which guidelines are created that enable developers to design accessible wearable apps and technologies. These guidelines will be created with developers who have experience with designing accessible technology and/or wearables. In addition, users who (potentially) experience problems with accessibility of wearables (persons who have a disability) are involved in the development of the guideline, to ensure their validity from an end-user perspective.

Developing Accessibility Design Guidelines for Wearables: Accessibility Standards for Multimodal Wearable Devices

Smart wearable devices are integrated our everyday lives. Such wearable technology is worn on or near the body, while leaving both hands free. This enables users to receive and send information in a non-obtrusive way. Because of the ability to continuously assist and support activities, wearables could be of great value to persons with a disability. Persons with a disability can only benefit from the potential of wearables if they are accessible. Like other devices, platforms, and applications, developers of wearables need to take accessibility into account during early development, for example by including multimodal interfaces in the design. Even though some accessibility guidelines and standards exist for websites and mobile phones, more support for the development of accessible wearables is needed. The aim of our project is to develop a set of guidelines for accessible wearables. Three approaches are combined to develop the guidelines. A scan of the literature was done to identify publications addressing the accessibility of wearables and/or development guidelines. Semi-structured interviews were held with developers of accessible wearable technology. Based on these first activities, a draft set of guidelines is created. This draft is evaluated with developers and researchers in the field of universal design, accessibility, and wearables. Further, the draft is evaluated with visually impaired people (VIP) in interviews. Based on these results, a final set of guidelines will be created. This set is evaluated against an actual project in which apps are developed for VIP. This study is in progress; first results are presented (literature study, semi-structured interviews, first draft of guidelines) and a call for participation in the Delphi study is issued.

Redesign Based on Card Sorting: How Universally Applicable are Card Sort Results?

Card sort studies can facilitate developers to create an information structure for their website or application. In addition, this human-centered design method provides researchers with insights into the target group’s mental models regarding the information domain under study. In this method, participants sort cards, with excerpts of the website’s or information source’s information on them, into piles or groups. Even though the method lends itself for large numbers of participants, it can be difficult to include sufficient participants in a study to ensure generalizability among large user groups. Especially when the potential user group is heterogeneous, basing the information structure on a limited participant group may not always be valid. In this study, we investigate if card-sort results among one user group (nurses) are comparable to the results of a second (potential) user group (physicians/residents).

Focus on Accessibility: Multimodal Healthcare Technology for All

New health technologies are not accessible to all users due to the circumstantial or permanent disabilities some users have. Especially in healthcare, attention must be paid to accommodating all potential users or patients. With the smart use of multimodal systems and multimedia solutions, a broader patient group can be reached. In this paper, we lay out the concept guidelines for accessible wearable technology. Wearables are used for many purposes, including health. The research on these guidelines is in progress, first recommendations based on preliminary outcomes are given.