Human Factors Approach to Design, Development, and Evaluation
Human factors methods and approaches are increasingly being used to inform the design and assessment of large-scale health information technologies (e.g. decision support systems, barcode medication administration systems). In this review, we observed that human factors approaches are also being widely applied to the design, development, and evaluation of patient-centered mobile applications, more information you can see here www.chargiesapp.com/. However, we identified only three studies that reported on both the design and subsequent evaluation of a mobile application, making it difficult to determine whether adopting a human factors approach to design results in applications that are more useful, usable or used (i.e. results in a good fit between user and technology). Previous research has shown that user involvement in system development can lead to greater utilization of the system, and greater satisfaction with the system, but we found no attempt to establish this relationship with mobile applications. Research demonstrating the potential benefits of seeking user input early in the development process is clearly needed.
Interestingly, the majority of apps described in the papers included in the review targeted one condition or disease. The Centers for Disease Control and Prevention in the US recently reported that 21% of adults aged 45-64 and 45% of adults aged over 65 have two or more chronic conditions. In Australia, over 50% of people aged >50 years have at least two chronic conditions. These figures bring to mind the question of whether designers of mobile health applications should be developing systems for patients with multiple conditions. Do we expect patients to use different medical applications for each of their conditions? An ideal app for facilitating patient-centered care coordination would be one that allowed patients to manage and track all their conditions (e.g. allowed documentation of symptoms for all conditions, triggered reminders for all medications, not just those for diabetes, for example). An app that is able to provide feedback about the interactions between an individual’s conditions and treatments could provide insights to allow patients to develop effective strategies for managing their health in a more holistic fashion. Such an app could be used to target clinical specialist silos, allowing patients to provide their clinicians with ongoing information about how a multiplicity of variables affect their health, not just information relating to a single condition and treatment. This surely would be a step towards more patient-centered care coordination. We didn’t find any medical application in our review that attempted to tackle the reality of patients with multiple system health problems.
Mobile Applications to Support Patient-centered Care Coordination
Patient-centered care coordination places consumers in a position where they have control of, and information about, their care to the level desired to deliver quality outcomes. Research investigating effective chronic disease management has shown that multi-component interventions are required to support patient-centered care coordination. These include elements such as organizational changes to the way health provider teams work and interact with patients, strategies that support patient engagement, and access to useful and relevant information for both providers and patients. Potential barriers to patient-centered coordination, particularly care planning during health care consultations, include poor health literacy, level of assertiveness and numeracy skills, along with a patient’s emotional state. Mobile applications are thus considered as potentially very useful tools for supporting patient-centered care coordination by facilitating new ways in which patients and providers can interact, and for providing access to information in a format tailored to patients’ needs. Importantly, the mobility of these interventions is key to allowing patients to engage or participate, and communicate outside formal health care consultations.
A key question is what methods are appropriate for assessing care coordination and measuring any possible changes to coordination following intervention implementation? In this review, we identified the two most common methods for app evaluation to be tracking of application use and patient surveys. Does the use of a mobile app feature equate to increased participation or engagement in one’s condition? Does a patient’s experience of improved communication with providers translate to detectable improvements in care coordination? And does this really matter, or are perceived improvements enough? In this review we did not identify any paper that went beyond app utilization or patient surveys to investigate the impact of mobile application use on health outcomes.
Limitations of the Study
A major challenge for our review was the inconsistent ways in which terms related to both ‘patient-centered’ and ‘care-coordination’ are used and defined. We thus used a range of strategies to identify papers reporting mobile applications that aimed to make some contribution to patients’ active involvement in the coordination of their care, but may not have captured all papers. We applied a fairly generous definition of a ‘human factors approach’, that is, use of methods such as surveys and interviews, were classified as a human factors approach. However the extent to which the researchers/designers had a good knowledge of human factors principles and were able to apply the information gained was often not possible to determine.
Overall, the potential of mobile health applications to assist patients and providers in coordinating care has resulted in a large number of applications being developed to facilitate patient participation and communication. Our review of papers showed that human factors approaches are nearly always adopted in the design, development, and evaluation of mobile applications. Evaluations of health applications that include an assessment of health outcomes would strengthen the evidence base for mobile application use to improve care coordination.
1 Applicaion Development