Nienke Beerlage-de Jong

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.

Technology to support integrated Antimicrobial Stewardship Programs: a user centered and stakeholder driven development approach

The rise of antimicrobial resistance (AMR) is a severe global health problem. Tackling this problem requires the prudent prescribing of antimicrobials. This is promoted through Antimicrobial Stewardship Programs (ASPs). In this position paper we describe i) how a socio-technical multidisciplinary approach (based on the CeHRes Roadmap) can be applied in the development and implementation of Antimicrobial Stewardship technologies and ii) how this approach can be of value to support Antimicrobial Stewardship in practice. The CeHRes Roadmap entails five different phases to explore and test how an eHealth technology can be tailored to the target group and successfully implemented in practice: i) contextual inquiry, ii) value specification, iii) design, iv) operationalization, v) evaluation. In this position paper we describe the lessons learned from research and practice to guide future developments of technology based ASP interventions. Since AMR is a huge wicked problem on a global level, it requires innovative methods and models to empower general public and professionals to be proactive rather than reactive in a digitalized world. We highlight how to combat the dangerous rise of antimicrobial resistance in the future.

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).

eHealth vs. Infection: participatory development of persuasive eHealth to support safe care

Antimicrobial resistance is a big global threat for public health. Many of the measures that are taken to tackle this problem – such as Anitbiotic Stewardship Programs (ASPs) – require healthcare professionals and patients to change their attitudes and/or behavior. This is not easily achieved, since negative consequences of negligence or incorrect behavior are not immediately visible, there are little incentives to change behavior and individual healthcare providers are not always aware of how they (can) contribute to the problem. The use of eHealth technology is promising for dealing with this kind of problems. The CeHRes Roadmap offers a framework for the development of such technology. It calls for a participatory development process, in which attention is not only paid to the technology, but also to its users (e.g. physicians) and the context within which it is used (e.g. nursing homes): a socio-technical approach. Besides that, the technology itself can, by applying persuasive design, stimulate and motivate its users to change their behavior and attitudes. The research that is described in this thesis was performed by the Center for eHealth and Wellbeing Research of the University of Twente, within the INTERREG IVa EurSafety Health-net project. This cross-border project aims to improve patient safety via the prevention and control of antimicrobial resistance. This thesis shows how a participatory development process and persuasive design of eHealth technology can contribute to the success of ASPs. Additionally, a method is described and evaluated to measure perceived persuasiveness of eHealth technology: the Perceived Persuasiveness Questionnaire.