Joyce Karreman

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unsupportive of ASP-related tasks, mainly because information is not structured to match nurse tasks, is hard to find, out of date, and insufficiently supportive of awareness.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.

Procedural and declarative information in user instructions: what we do and don't know about these information types

The use and the effects of different information types in user instructions are not completely clear. Research showed that procedural information (information about the actions) is the most important information type during use. Research results about the effects of declarative information (explanatory information) are not conclusive. It is known that users are interested in declarative information, but it is not known in which situations they read this information and in which situations this information affects task performance. Furthermore, it is not clear which different types of declarative information have to be distinguished. In this paper, we describe what is known about different information types in user instructions and what is not yet known. On the basis of our analysis, we propose follow-up experiments and we recommend practitioners to consider the possible advantages and disadvantages of including declarative information in instructions for use.

Some effects of system information in instructions for use

An experiment was carried out to investigate whether it is useful to add system information to procedural information in instructional text. It was assumed that readers of instructions construct both a procedural and a system mental model, and that the latter enables the readers to infer possible missing information in procedural instructions. Moreover, it was assumed that system information would increase the cognitive load during reading and practicing, and that it would affect the appreciation of the instructions as well as the self-efficacy of the reader. The participants in the experiment read instructions and practiced with a fictitious machine before performing a number of tasks and answering a questionnaire. The results indicate that system information increased the cognitive load during reading and decreased self-efficacy, while the instructional text with system information was judged as more difficult. The effect on performance is limited: system information leads to faster performance for correctly completed tasks.

Validation of the Instructional Materials Motivation Survey (IMMS) in a self-directed instructional setting aimed at working with technology

The ARCS Model of Motivational Design has been used myriad times to design motivational instructions that focus on attention, relevance, confidence and satisfaction in order to motivate students. The Instructional Materials Motivation Survey (IMMS) is a 36-item situational measure of peoples reactions to instructional materials in the light of the ARCS model. Although the IMMS has been used often, both as a pretest and a posttest tool serving as either a motivational needs assessment prior to instruction or a measure of peoples reactions to instructional materials afterward, the IMMS so far has not been validated extensively, taking statistical and theoretical aspects of the survey into account. This paper describes such an extensive validation study, for which the IMMS was used in a self-directed instructional setting aimed at working with technology (a cellular telephone). Results of structural equation modeling show that the IMMS can be reduced to 12 items. This Reduced Instructional Materials Motivation Survey IMMS (RIMMS) is preferred over the original IMMS. The parsimonious RIMMS measures the four constructs attention, relevance, confidence and satisfaction of the ARCS model well, and reflects its conditional nature.

Effects of declarative information in instructions for use

Adding declarative information to the essential procedural information in instructions for use might have different effects. Previous research examined the effect of declarative information on the ability to work with the system that is described in the instructions. However, the results of the various experiments were not conclusive. Moreover, other possible effects of declarative information were never investigated before. In the present experiment, the effects of two different types of declarative information on task performance, on cognitive load and on self-efficacy were examined. The results demonstrated that the two types of declarative information negatively affected cognitive load and self-efficacy ratings. The effects on task performance were positive, but moderate.

Designing government portal navigation around citizens’ needs

Improving the usability of government portal sites requires a focus shift from system to user in both research and design. Empirical studies into user behavior are needed to support decisions on navigation, labeling and search systems. This paper presents such a study. Through scenario based interviews data were collected on citizens’ information seeking needs and search strategies. Additionally, server logs files were analyzed. The results demonstrated the complexity of the search task from a user perspective, and provided suggestions for user friendly portal design. On the basis of the results it was recommended that portal sites’ navigation systems should be context-rich, and labeling systems should be adapted to citizens’ colloquial speech.

The new face of procedural content: a real world approach

This paper describes a large-scale project to improve the effectiveness of knowledge base (KB) articles on a support website in solving problems experienced by novice to intermediate computer users. The project encompasses the structure of the content, the quality of the writing and graphics, and the user interface presentation. In addition, we are developing guidelines intended for the designers and writers of new KB articles. We leveraged product knowledge, research findings, and extensive experience in user support to develop and empirically test three prototypes. Preliminary test results show improved solve rates ranging from 17% to 26%, with still better results from pilot content currently released to the public.

Implementation of MRSA Infection Prevention and Control Measures – What Works in Practice?

There have been increasing numbers of media reports about careless behaviour by healthcare workers, mainly involving insufficient cleaning practices and the absence of hand hygiene measures (Boyce, 2009). Although adherence to infection prevention and control measures has received a lot of attention in the media and in scientific literature, surprisingly little attention has been given to the implementation of the infection prevention and control strategies in healthcare practices. In the medical literature the focus is on the availability of national or regional MRSA surveillance data and guidelines for prevention and control. To date hardly any data has been made available about the kinds of interventions that have been successful in implementing infection prevention and control.

Navigating on web sites: Exploring the life events approach

To help users find their way on complex web sites, an adequate information architecture and navigation design is important. Currently, a navigational structure based on so-called life events is becoming increasingly popular. In close cooperation with the Dutch Tax and Customs Administration, we executed two studies (a card sort study and a comparative usability test) to investigate the attitude and experiences of the users with regard to a web site based on life events. The results of the card sort study showed that citizens do not spontaneously think about life events as a possible way to categorize and label content elements of a government web site. The results of the usability test showed that a navigational structure based on life events does not lead to more effective or efficient search processes. A web site with a navigational structure based on life events is as usable as a structure based on themes.

Effecten van positief geladen informatie en geografische nabijheid in de corporate communicatie van een waterschap

A good reputation has become increasingly important for governmental organisations. These organisations can promote their reputation by means of their corporate communication. In this study, the effects of two textual characteristics of a District Water Board’s leaflet are measured: the presence of positively charged information and geographical vicinity. It was expected that both characteristics would have positive effects on the readers’ appreciation of the leaflet, on the organisation’s reputation and on the readers’ compliance (willingness to pay taxes). The presence of positively charged information did not have any effect, but geographical vicinity had positive effects on all three variables. Participants who read a leaflet with information about the Water Board’s activities in their home town appreciated the information more, were more positive about the organisation’s reputation and had higher compliance scores, compared to participants who read a leaflet with information about the Water Board’s entire control area.