Research Activities, December 2011: Health Information Technology: Many challenges remain in the design and use of consumer health informatics interventions

Many challenges remain in the design and use of consumer health informatics interventions

A growing number of people are using Web-based programs, such as Microsoft HealthVault and Google Health to monitor their health in conjunction with devices such as blood pressure cuffs, weight scales, and pedometers. However, patients may have trouble using these consumer health informatics (CHI) interventions at home—as partially evidenced by Google's choice to discontinue Google Health as of January 1, 2012. A new study finds that such interventions can pose a variety of human factors challenges in their use. Agency for Healthcare Research and Quality (AHRQ) researcher Teresa Zayas-Cabán, Ph.D., and Jenna L. Marquard, Ph.D. from the University of Massachusetts Amherst, found significant challenges on a number of levels for consumers using these interventions.
They developed four CHI intervention use cases for individuals with diabetes and high blood pressure and also for bariatric surgery patients. Two student volunteers acted as patients while a third student acted as the provider. The three students tested each intervention for 10 days. Each intervention involved a variety of tasks, such as taking blood pressure and glucose readings, recording pedometer and weight readings, and recording their food intake online using HealthVault and Google Health. The students then recorded their challenges while completing each task and rated the severity of each challenge. Two independent evaluators then classified the challenges into one of three well-known human factors areas: cognitive, macroergonomic, or physical.
A total of 122 challenges were identified. Half of these were classified as cognitive, 38 percent macroergonomic (e.g., using the interventions in the context of their daily life), and 12 percent physical. Approximately a third of all challenges were reported by the students as being at least moderately severe. HealthVault posed more severe challenges than Google Health for both the diabetes and bariatric surgery use cases. The physical challenges most often related to the use of linked devices, such as blood pressure cuffs and weight scales. Cognitive challenges were associated the most with one-time activities, such as learning to use these devices and their applications. Most of the macroergonomic challenges involved repeated activities such as uploading device data. The researchers' evaluation approach identified a significant number of challenges likely to interfere with lay people's ability to use a particular CHI intervention. These identified challenges provide designers with a starting place from which to begin redesigning the intervention.
More details are in "Commercial off-the-shelf consumer health informatics interventions: Recommendations for their design, evaluation and redesign," by Dr. Marquard and Dr. Zayas-Cabán, in the July 1, 2011, Journal of the American Medical Informatics Association. [Epub ahead of publication.] Reprints (AHRQ Publication No. 11-R075) are available from the AHRQ Publications Clearinghouse.

Research Activities, December 2011: Health Information Technology: Many challenges remain in the design and use of consumer health informatics interventions