School of Rehabilitation, Université de Sherbrooke, Sherbrooke, QC, Canada.
Center for Research on Aging, Sherbrooke, QC, Canada.
J Med Internet Res. 2020 Aug 10;22(8):e16175. doi: 10.2196/16175.
A clinical algorithm (Algo) in paper form is used in Quebec, Canada, to allow health care workers other than occupational therapists (OTs) to make bathroom adaptation recommendations for older adults. An integrated knowledge transfer process around Algo suggested an electronic version of this decision support system (electronic decision support system [e-DSS]) to be used by older adults and their caregivers in search of information and solutions for their autonomy and safety in the bathroom.
This study aims to (1) create an e-DSS for the self-selection of bathroom-assistive technology by community-dwelling older adults and their caregivers and (2) assess usability with lay users and experts to improve the design accordingly.
On the basis of a user-centered design approach, the process started with content identification for the prototype through 7 semistructured interviews with key informants of various backgrounds (health care providers, assistive technology providers, and community services) and 4 focus groups (2 with older adults and 2 with caregivers). A thematic content transcript analysis was carried out and used during the creation of the prototype. The prototype was refined iteratively using think-aloud and observation methods with a clinical expert (n=1), researchers (n=3), OTs (n=3), older adults (n=3), and caregivers (n=3), who provided information on the usability of the e-DSS.
Overall, 4 themes served as the criteria for the prototype of the electronic Algo (Hygiene 2.0 [H.0]): focus (safety, confidentiality, well-being, and autonomy), engage, facilitate (simplify, clarify, and illustrate), and access. For example, users first pay attention to the images (engage and illustrate) that can be used to depict safe postures (safety), illustrate questions embedded in the decision support tool (clarify and illustrate), and demonstrate the context of the use of assistive technology (safety and clarify).
The user-centered design of H.0 allowed the cocreation of an e-DSS in the form of a website, in line with the needs of community-dwelling older adults and their caregivers seeking bathroom-assistive technology that enables personal hygiene. Each iteration improved usability and brought more insight into the users' realities, tailoring the e-DSS to the implementation context.
加拿大魁北克省使用一种纸质临床算法（Algo），允许非职业治疗师（OT）的医疗保健工作者为老年人提出浴室适应性建议。围绕 Algo 的综合知识转移过程建议开发一种针对老年人及其护理人员的浴室辅助技术自我选择的电子决策支持系统（电子决策支持系统 [e-DSS]），以帮助他们在浴室中寻找信息和解决方案，以实现自主和安全。
本研究旨在（1）为社区居住的老年人及其护理人员创建一个用于自助选择浴室辅助技术的 e-DSS，（2）通过与非专业用户和专家进行可用性评估来改进设计。
基于以用户为中心的设计方法，该过程首先通过对不同背景的关键信息提供者（包括医疗保健提供者、辅助技术提供者和社区服务提供者）进行 7 次半结构化访谈和 4 次焦点小组（2 次针对老年人，2 次针对护理人员），确定了原型的内容。进行了主题内容的转录分析，并在原型创建过程中使用了该分析。通过与临床专家（n=1）、研究人员（n=3）、OT（n=3）、老年人（n=3）和护理人员（n=3）进行的出声思维和观察方法，迭代式地改进了原型，这些用户提供了有关 e-DSS 可用性的信息。
总体而言，4 个主题作为电子 Algo 原型的标准（卫生 2.0 [H.0]）：重点（安全、保密性、幸福感和自主性）、参与、促进（简化、澄清和说明）和访问。例如，用户首先关注图像（参与和说明），这些图像可用于描绘安全姿势（安全），说明决策支持工具中嵌入的问题（澄清和说明），并展示辅助技术使用的上下文（安全和澄清）。
H.0 的以用户为中心的设计允许以网站的形式共同创建 e-DSS，符合社区居住的老年人及其护理人员对浴室辅助技术的需求，这些技术可帮助他们进行个人卫生。每次迭代都提高了可用性，并使我们对用户的实际情况有了更深入的了解，使 e-DSS 能够适应实施环境。
