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  • 1. Boman, Inga-Lill
    et al.
    Ehn, Maria
    Mälardalen University, School of Innovation, Design and Engineering, Embedded Systems.
    Sjölinder, Marie
    Folke, Mia
    Mälardalen University, School of Innovation, Design and Engineering, Embedded Systems.
    Hansson, Pär
    Sommerfeld, Disa
    Borg, Jörgen
    Users´ and health-care professionals´ contributions in developing a home-based stroke rehabilitation tool2014Conference paper (Refereed)
  • 2.
    Ehn, Maria
    et al.
    Mälardalen University, School of Innovation, Design and Engineering, Embedded Systems.
    Carlén Eriksson, Lennie
    Mälardalen University, School of Innovation, Design and Engineering, Embedded Systems.
    Åkerberg, Nina
    Västerås Municipality, Västerås, Sweden.
    Johansson, Ann-Christin
    Mälardalen University, School of Health, Care and Social Welfare, Health and Welfare.
    Activity Monitors as Support for Older Persons’ Physical Activity in Daily Life: Qualitative Study of the Users’ Experiences2018In: JMIR mhealth and uhealth, E-ISSN 2291-5222, Vol. 6, no 2, article id e34Article in journal (Refereed)
    Abstract [en]

    Background

    Falls are a major threat to the health and independence of seniors. Regular physical activity (PA) can prevent 40% of all fall injuries. The challenge is to motivate and support seniors to be physically active. Persuasive systems can constitute valuable support for persons aiming at establishing and maintaining healthy habits. However, these systems need to support effective behavior change techniques (BCTs) for increasing older adults’ PA and meet the senior users’ requirements and preferences. Therefore, involving users as codesigners of new systems can be fruitful. Prestudies of the user’s experience with similar solutions can facilitate future user-centered design of novel persuasive systems.

    Objective

    The aim of this study was to investigate how seniors experience using activity monitors (AMs) as support for PA in daily life. The addressed research questions are as follows: (1) What are the overall experiences of senior persons, of different age and balance function, in using wearable AMs in daily life?; (2) Which aspects did the users perceive relevant to make the measurements as meaningful and useful in the long-term perspective?; and (3) What needs and requirements did the users perceive as more relevant for the activity monitors to be useful in a long-term perspective?

    Methods

    This qualitative interview study included 8 community-dwelling older adults (median age: 83 years). The participants’ experiences in using two commercial AMs together with tablet-based apps for 9 days were investigated. Activity diaries during the usage and interviews after the usage were exploited to gather user experience. Comments in diaries were summarized, and interviews were analyzed by inductive content analysis.

    Results

    The users (n=8) perceived that, by using the AMs, their awareness of own PA had increased. However, the AMs’ impact on the users’ motivation for PA and activity behavior varied between participants. The diaries showed that self-estimated physical effort varied between participants and varied for each individual over time. Additionally, participants reported different types of accomplished activities; talking walks was most frequently reported. To be meaningful, measurements need to provide the user with a reliable receipt of whether his or her current activity behavior is sufficient for reaching an activity goal. Moreover, praise when reaching a goal was described as motivating feedback. To be useful, the devices must be easy to handle. In this study, the users perceived wearables as easy to handle, whereas tablets were perceived difficult to maneuver. Users reported in the diaries that the devices had been functional 78% (58/74) of the total test days.

    Conclusions

    Activity monitors can be valuable for supporting seniors’ PA. However, the potential of the solutions for a broader group of seniors can significantly be increased. Areas of improvement include reliability, usability, and content supporting effective BCTs with respect to increasing older adults’ PA.

  • 3.
    Ehn, Maria
    et al.
    Mälardalen University, School of Innovation, Design and Engineering, Embedded Systems.
    Derneborg, M.
    Region Västmanland, Västerås, Sweden.
    Revenäs, Åsa
    Mälardalen University, School of Health, Care and Social Welfare, Health and Welfare. Region Västmanland, Ortopedkliniken Västerås.
    Cicchetti, Antonio
    Mälardalen University, School of Innovation, Design and Engineering, Embedded Systems.
    User-centered requirements engineering to manage the fuzzy front-end of open innovation in e-health: A study on support systems for seniors’ physical activity2021In: International Journal of Medical Informatics, ISSN 1386-5056, E-ISSN 1872-8243, Vol. 154, article id 104547Article in journal (Refereed)
    Abstract [en]

    Background: Although e-health potentials for improving health systems in their safety, quality and efficiency has been acknowledged, a large gap between the postulated and empirically demonstrated benefits of e-health technologies has been ascertained. E-health development has classically been technology-driven, often resulting in the design of devices and applications that ignore the complexity of the real-world setting, thus leading to slow diffusion of innovations to care. Therefore, e-health innovation needs to consider the mentioned complexity already from the start. The early phases of innovation, fuzzy front-end (FFE) defined as “the period between when an opportunity is first considered and when an idea is judged ready for development” has been identified to have the highest impact on the innovation process and its outcome. The FFE has been recognized as the most difficult stage to manage in the innovation process as it involves a high degree of uncertainty. Such a phase becomes even more difficult when different sectors and organizations are involved. Therefore, effective methods for involving different organizations and user groups in the FFE of innovation are needed. Objective: The aim of this study was to manage the FFE of a collaborative, open innovation (OI) process, to define a software system supporting seniors’ physical activity (PA) by applying a framework of methods from software requirements engineering (RE) to elicit and analyze needs and requirements of users and stakeholders, as well as the context in which the system should be used. Methods: Needs and requirements of three future user groups were explored through individual- and focus group interviews. Requirements were categorized and analyzed in a workshop with a multidisciplinary team: a system overview was produced by conceptual modelling using elicited functional requirements; high-level non-functional requirements were negotiated and prioritized. Scenario descriptions of system's supportive roles in different phases of a behavioral change process were developed. Results: User-centered RE methods were successfully used to define a system and a high-level requirements description was developed based on needs and requirements from three identified user groups. The system aimed to support seniors’ motivation for PA and contained four complementary sub-systems. The outcome of the study was a Concept of Operations (ConOps) document that specified the high-level system requirements in a way that was understandable for stakeholders. This document was used both to identify and recruit suitable industrial partners for the following open innovation development and to facilitate communication and collaboration in the innovation process. Conclusions: Applying software RE methods and involving user groups in the early phases of OI can contribute to the development of new concepts that meet complex real-world requirements. Different user groups can complement each other in conveying needs and requirements from which systems can be designed. Empirical studies applying and exploring different methods used to define new e-health solutions can contribute with valuable knowledge about handling innovation FFE.

  • 4.
    Ehn, Maria
    et al.
    Mälardalen University, School of Innovation, Design and Engineering, Embedded Systems.
    Derneborg, Mattias
    Region Västmanland, Sweden.
    Ekström, Martin
    Mälardalen University, School of Innovation, Design and Engineering, Embedded Systems.
    Johansson, Ann-Christin
    Mälardalen University, School of Health, Care and Social Welfare, Health and Welfare.
    Inter- disciplinary and -sectorial cooperation for development of technology supporting behavioral change: Peer reviewed poster abstract2017Conference paper (Other academic)
  • 5.
    Ehn, Maria
    et al.
    Mälardalen University, School of Innovation, Design and Engineering, Embedded Systems.
    Hansson, P.
    SICS Swedish ICT, Kista, Sweden.
    Sjölinder, M.
    SICS Swedish ICT, Kista, Sweden.
    Boman, I. -L
    Karolinska Institutet, Solna, Sweden .
    Folke, Mia
    Mälardalen University, School of Innovation, Design and Engineering, Embedded Systems.
    Sommerfeld, D.
    SICS Swedish ICT, Kista, Sweden.
    Borg, J.
    SICS Swedish ICT, Kista, Sweden.
    Palmcrantz, S.
    SICS Swedish ICT, Kista, Sweden.
    Users perspectives on interactive distance technology enabling home-based motor training for stroke patients2015In: Studies in Health Technology and Informatics, vol. 211, 2015, p. 145-152Conference paper (Refereed)
    Abstract [en]

    The aim of this work has been to develop a technical support enabling home-based motor training after stroke. The basis for the work plan has been to develop an interactive technical solution supporting three different groups of stroke patients: (1) patients with stroke discharged from hospital with support from neuro team; (2) patients with stroke whose support from neuro team will be phased out and (3) patients living with impaired motor functions long-term. The technology has been developed in close collaboration with end-users using a method earlier evaluated and described [12]. This paper describes the main functions of the developed technology. Further, results from early user-tests with end-users, performed to identify needs for improvements to be carried out during further technical development. The developed technology will be tested further in a pilot study of the safety and, usefulness of the technology when applied as a support for motor training in three different phases of the post-stroke rehabilitation process. 

  • 6.
    Ehn, Maria
    et al.
    Mälardalen University, School of Innovation, Design and Engineering, Embedded Systems.
    Hansson, Pär
    SICS Swedish ICT, Stockholm, Sweden.
    Sjölinder, Marie
    SICS Swedish ICT, Stockholm, Sweden.
    Boman, Inga-Lill
    Karolinska Institutet, Stockholm, Sweden.
    Folke, Mia
    Mälardalen University, School of Innovation, Design and Engineering, Embedded Systems.
    Sommerfeld, Disa
    Karolinska Institutet, Stockholm, Sweden.
    Borg, Jörgen
    Karolinska Institutet, Stockholm, Sweden.
    Interaktiv distanslösning för motorisk träning av patienter med stroke i hemmiljö2014In: Medicinteknikdagarna 2014 MTD10, 2014Conference paper (Refereed)
  • 7.
    Ehn, Maria
    et al.
    Mälardalen University, School of Innovation, Design and Engineering, Embedded Systems.
    Johansson, Ann-Christin
    Mälardalen University, School of Health, Care and Social Welfare, Health and Welfare.
    Revenäs, Åsa
    Mälardalen University, School of Health, Care and Social Welfare, Health and Welfare. Region Västmanland.
    Technology-Based Motivation Support for Seniors' Physical Activity-A Qualitative Study on Seniors' and Health Care Professionals' Views2019In: International Journal of Environmental Research and Public Health, ISSN 1661-7827, E-ISSN 1660-4601, Vol. 16, no 13Article in journal (Refereed)
    Abstract [en]

    This paper investigates seniors' and health care professionals' (HCPs) perceptions on needed contributions and qualities of digital technology-based motivation support for seniors' physical activity (PA). Seniors and HCPs expressed their views in focus groups, which were analyzed separately by inductive content analysis. Similarities and differences in seniors' and HCPs' views were identified through thematic analysis of qualitative results from both focus groups. This article's main findings are that both seniors and HCPs believed digital technology should support and make PA more enjoyable in ways to strengthen seniors' control and well-being. However, seniors emphasized support for social interaction, while HCPs also requested support for increasing seniors' insight into PA and for facilitating their dialogue with seniors. Conclusions to be drawn are that seniors and HPCs shared overall views on digital technology's main contributions but had different perspectives on how those contributions could be obtained. This highlights the importance of the early identification of user groups and exploration of their different needs when developing new solutions. Moreover, seniors' and HCPs' perceptions included aspects relevant for personal motivation, technology acceptance, and PA behavioral change according to self-determination theory, unified theory of acceptance and use of technology, and behavioral change techniques for increasing PA.

  • 8.
    Ehn, Maria
    et al.
    Mälardalen University, School of Innovation, Design and Engineering, Embedded Systems.
    Kristoffersson, Annica
    Mälardalen University, School of Innovation, Design and Engineering, Embedded Systems.
    Clinical sensor-based fall risk assessment at an orthopedic clinic: A case study of the staff’s views on utility and effectiveness2023In: Sensors, E-ISSN 1424-8220, Vol. 23, no 4, article id 1904Article in journal (Refereed)
    Abstract [en]

    In-hospital falls are a serious threat to patient security and fall risk assessment (FRA) is important to identify high-risk patients. Although sensor-based FRA (SFRA) can provide objective FRA, its clinical use is very limited and research to identify meaningful SFRA methods is required. This study aimed to investigate whether examples of SFRA methods might be relevant for FRA at an orthopedic clinic. Situations where SFRA might assist FRA were identified in a focus group interview with clinical staff. Thereafter, SFRA methods were identified in a literature review of SFRA methods developed for older adults. These were screened for potential relevance in the previously identified situations. Ten SFRA methods were considered potentially relevant in the identified FRA situations. The ten SFRA methods were presented to staff at the orthopedic clinic, and they provided their views on the SFRA methods by filling out a questionnaire. Clinical staff saw that several SFRA tasks could be clinically relevant and feasible, but also identified time constraints as a major barrier for clinical use of SFRA. The study indicates that SFRA methods developed for community-dwelling older adults may be relevant also for hospital inpatients and that effectiveness and efficiency are important for clinical use of SFRA.

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  • 9.
    Ehn, Maria
    et al.
    Mälardalen University, School of Innovation, Design and Engineering, Embedded Systems.
    Richardson, Matt X.
    Mälardalen University, School of Health, Care and Social Welfare, Health and Welfare.
    Landerdahl Stridsberg, Sara
    Redekop, Ken
    Mälardalen University, School of Health, Care and Social Welfare, Health and Welfare.
    Wamala, Sarah
    Mälardalen University, School of Health, Care and Social Welfare, Health and Welfare.
    Mobile Safety Alarms Based on GPS Technology in the Care of Older Adults: Systematic Review of Evidence Based on a General Evidence Framework for Digital Health Technologies.2021In: Journal of Medical Internet Research, E-ISSN 1438-8871, Vol. 23, no 10, article id e27267Article in journal (Refereed)
    Abstract [en]

    BACKGROUND: GPS alarms aim to support users in independent activities. Previous systematic reviews have reported a lack of clear evidence of the effectiveness of GPS alarms for the health and welfare of users and their families and for social care provision. As GPS devices are currently being implemented in social care, it is important to investigate whether the evidence of their clinical effectiveness remains insufficient. Standardized evidence frameworks have been developed to ensure that new technologies are clinically effective and offer economic value. The frameworks for analyzing existing evidence of the clinical effectiveness of GPS devices can be used to identify the risks associated with their implementation and demonstrate key aspects of successful piloting or implementation.

    OBJECTIVE: The principal aim of this study is to provide an up-to-date systematic review of evidence based on existing studies of the effects of GPS alarms on health, welfare, and social provision in the care of older adults compared with non-GPS-based standard care. In addition, the study findings were assessed by using the evidence standards framework for digital health technologies (DHTs) established by the National Institute for Health and Care Excellence (NICE) in the United Kingdom.

    METHODS: This review was conducted according to the PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) guidelines. Primary studies published in peer-reviewed journals and gray literature from January 2005 to August 2020 were identified through searches in 13 databases and several sources of gray literature. Included studies had individuals (aged ≥50 years) who were receiving social care for older adults or for persons with dementia; used GPS devices as an intervention; were performed in Canada, the United States, European Union, Singapore, Australia, New Zealand, Hong Kong, South Korea, or Japan; and addressed quantitative outcomes related to health, welfare, and social care. The study findings were analyzed by using the NICE framework requirements for active monitoring DHTs.

    RESULTS: Of the screened records, 1.6% (16/986) were included. Following the standards of the NICE framework, practice evidence was identified for the tier 1 categories Relevance to current pathways in health/social care system and Acceptability with users, and minimum evidence was identified for the tier 1 category Credibility with health, social care professionals. However, several evidence categories for tiers 1 and 2 could not be assessed, and no clear evidence demonstrating effectiveness could be identified. Thus, the evidence required for using DHTs to track patient location according to the NICE framework was insufficient.

    CONCLUSIONS: Evidence of the beneficial effects of GPS alarms on the health and welfare of older adults and social care provision remains insufficient. This review illustrated the application of the NICE framework in analyses of evidence, demonstrated successful piloting and acceptability with users of GPS devices, and identified implications for future research.

  • 10.
    Ehn, Maria
    et al.
    Mälardalen University, School of Innovation, Design and Engineering, Embedded Systems.
    Ström, Lars
    Livanda-Internetkliniken, Sweden.
    Johansson, Titti
    Region Västmanland, Sweden.
    Cicchetti, Antonio
    Mälardalen University, School of Innovation, Design and Engineering, Embedded Systems.
    Revenäs, Åsa
    Mälardalen University, School of Health, Care and Social Welfare, Health and Welfare. Region Västmanland, Ortopedkliniken Västerås, Sweden.
    SALUTOGEN: User-center development and prototype testing of a system supporting seniors’ physical activity for fall prevention2019Conference paper (Refereed)
    Abstract [en]

    Background:

    Physical activity (PA) can contribute to fall prevention among seniors. Many seniors need to increase their PA and regularly perform balance-enhancing activities. Changing behavior is often challenging, especially long-term. Therefore, support for change and long-term maintenance of PA behavior contributing to fall prevention is essential. Technology-based applications are widely exploited to support PA but do not match seniors’ needs. Therefore, new solutions are needed that support seniors’ PA for fall prevention leveraging theory for behavioral change and the specific target user’ needs.

    Aim, Method:

    SALUTOGEN is a research and innovation project aiming to develop and test a system prototype of technology-based motivation support for seniors’ PA including balance training. The developed technology includes apps for tablet and mobile phone that together provide seniors with motivation support for PA, activity measurement and video-coaching. 

    The project is based on iterative user-centered methodology including: development of needed app components; evaluation of single apps and their integration; pilot feasibility evaluation with seniors and coaches in real world settings.  

    Results:

    Valuable feedback from seniors was collected and used in the iterative development, especially from the motivation support perspective. The evaluation showed that the apps must be very intuitive and easy to understand. Preliminary results from the on-going pilot evaluation indicate that the coaching is highly appreciated by seniors and coaches. Moreover, the seniors’ and coaches’ experience in using the technology highly depends on the technology’s usability and reliability. 

    Conclusions:

    Technology-based interventions can play an important role in supporting seniors’ PA for fall prevention. Results from the project indicate that solution’s key elements are perceived important and appreciated by seniors and coaches. However, it is crucial for the users that the technical applications are light, intuitive and robust.

  • 11.
    Kristoffersson, Annica
    et al.
    Mälardalen University, School of Innovation, Design and Engineering, Embedded Systems.
    Du, Jiaying
    Motion Control AB, Sweden.
    Ehn, Maria
    Mälardalen University, School of Innovation, Design and Engineering, Embedded Systems.
    Performance and Characteristics of Wearable Sensor Systems Discriminating and Classifying Older Adults According to Fall Risk: A Systematic Review2021In: Sensors, E-ISSN 1424-8220, Vol. 21, no 17, article id 5863Article, review/survey (Refereed)
    Abstract [en]

    Sensor-based fall risk assessment (SFRA) utilizes wearable sensors for monitoring individuals’ motions in fall risk assessment tasks. Previous SFRA reviews recommend methodological improvements to better support the use of SFRA in clinical practice. This systematic review aimed to investigate the existing evidence of SFRA (discriminative capability, classification performance) and methodological factors (study design, samples, sensor features, and model validation) contributing to the risk of bias. The review was conducted according to recommended guidelines and 33 of 389 screened records were eligible for inclusion. Evidence of SFRA was identified: several sensor features and three classification models differed significantly between groups with different fall risk (mostly fallers/non-fallers). Moreover, classification performance corresponding the AUCs of at least 0.74 and/or accuracies of at least 84% were obtained from sensor features in six studies and from classification models in seven studies. Specificity was at least as high as sensitivity among studies reporting both values. Insufficient use of prospective design, small sample size, low in-sample inclusion of participants with elevated fall risk, high amounts and low degree of consensus in used features, and limited use of recommended model validation methods were identified in the included studies. Hence, future SFRA research should further reduce risk of bias by continuously improving methodology.

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  • 12.
    Landerdahl Stridsberg, Sara
    et al.
    Mälardalen University.
    Richardson, Matt
    Mälardalen University, School of Health, Care and Social Welfare, Health and Welfare.
    Redekop, K.
    Erasmus School of Health Policy and Management, Erasmus Universiteit Rotterdam, Rotterdam, Netherlands.
    Ehn, Maria
    Mälardalen University, School of Innovation, Design and Engineering, Embedded Systems.
    Wamala, Sarah
    Mälardalen University, School of Health, Care and Social Welfare, Health and Welfare.
    Gray Literature in Evaluating Effectiveness in Digital Health and Health and Welfare Technology: A Source Worth Considering2022In: Journal of Medical Internet Research, E-ISSN 1438-8871, Vol. 24, no 3, article id e29307Article in journal (Refereed)
    Abstract [en]

    BACKGROUND: The need to assess the effectiveness and value of interventions involving digital health and health and welfare technologies is becoming increasingly important due to the rapidly growing development of these technologies and their areas of application. Systematic reviews of scientific literature are a mainstay of such assessment, but publications outside the realm of traditional scientific bibliographic databases-known as gray literature-are often not included. This is a disadvantage, particularly apparent in the health and welfare technology (HWT) domain. OBJECTIVE: The aim of this article is to investigate the significance of gray literature in digital health and HWT when reviewing literature. As an example, the impact of including gray literature to the result of two systematic reviews in HWT is examined. METHODS: In this paper, we identify, discuss, and suggest methods for including gray literature sources when evaluating effectiveness and appropriateness for different review types related to HWT. The analysis also includes established sources, search strategies, documentation, and reporting of searches, as well as bias and credibility assessment. The differences in comparison to scientific bibliographic databases are elucidated. We describe the results, challenges, and benefits of including gray literature in 2 examples of systematic reviews of HWT. RESULTS: In the 2 systematic reviews described in this paper, most included studies came from context-specific gray literature sources. Gray literature contributed to the overall result of the reviews and corresponded well with the reviews' aims. The assessed risk of bias of the included studies derived from gray literature was similar to the included studies from other types of sources. However, because of less standardized publication formats, assessing and extracting data from gray literature studies were more time-consuming and compiling statistical results was not possible. The search process for gray literature required more time and the reproducibility of gray literature searches were less certain due to more unstable publication platforms. CONCLUSIONS: Gray literature is particularly relevant for digital health and HWT but searches need to be conducted systematically and reported transparently. This way gray literature can broaden the range of studies, highlight context specificity, and decrease the publication bias of reviews of effectiveness of HWT. Thus, researchers conducting systematic reviews related to HWT should consider including gray literature based on a systematic approach.

  • 13.
    Palmcrantz, Susanne
    et al.
    Karolinska Institutet, Sweden.
    Borg, Jörgen
    Karolinska Institutet, Sweden.
    Sommerfeld, Disa
    Karolinska Institutet, Sweden.
    Plantin, Jeanette
    Karolinska Institutet, Sweden.
    Wall, Annelie
    Karolinska Institutet, Sweden.
    Ehn, Maria
    Mälardalen University, School of Innovation, Design and Engineering, Embedded Systems.
    Sjölinder, Marie
    SICS, Swedish ICT, Stockholm, Sweden.
    Boman, Inga-Lill
    Karolinska Institutet, Sweden.
    An interactive distance solution for stroke rehabilitation in the home setting: A feasibility study2017In: Informatics for Health and Social Care, ISSN 1753-8157, E-ISSN 1753-8165, Vol. 42, no 3, p. 303-320Article in journal (Refereed)
    Abstract [en]

    In this study an interactive distance solution (called the DISKO tool) was developed to enable home-based motor training after stroke. Objectives: The overall aim was to explore the feasibility and safety of using the DISKO-tool, customized for interactive stroke rehabilitation in the home setting, in different rehabilitation phases after stroke. Methods: Fifteen patients in three different stages in the continuum of rehabilitation after stroke participated in a home-based training program using the DISKO-tool. The program included 15 training sessions with recurrent follow-ups by the integrated application for video communication with a physiotherapist. Safety and feasibility were assessed from patients, physiotherapists, and a technician using logbooks, interviews, and a questionnaire. Qualitative content analysis and descriptive statistics were used in the analysis. Results: Fourteen out of 15 patients finalized the training period with a mean of 19.5 minutes spent on training at each session. The DISKO-tool was found to be useful and safe by patients and physiotherapists. Conclusions: This study demonstrates the feasibility and safety of the DISKO-tool and provides guidance in further development and testing of interactive distance technology for home rehabilitation, to be used by health care professionals and patients in different phases of rehabilitation after stroke.

  • 14.
    Revenäs, Åsa
    et al.
    Mälardalen University, School of Health, Care and Social Welfare, Health and Welfare. Region Västmanland, Ortopedkliniken Västerås, Sweden.
    Johansson, Ann-Christin
    Mälardalen University, School of Health, Care and Social Welfare, Health and Welfare.
    Ehn, Maria
    Mälardalen University, School of Innovation, Design and Engineering, Embedded Systems.
    Integrating key user characteristics in user-centered design of digital support systems for seniors’ physical activity interventions to prevent falls: Protocol for a usability study2020In: JMIR Research Protocols, E-ISSN 1929-0748, Vol. 9, no 12, article id e20061Article in journal (Refereed)
    Abstract [en]

    Background: The goal of user-centered design (UCD) is to understand the users’ perspective and to use that knowledge to shape more effective solutions. The UCD approach provides insight into users’ needs and requirements and thereby improves the design of the developed services. However, involving users in the development process does not guarantee that feedback from different subgroups of users will shape the development in ways that will make the solutions more useful for the entire target user population. Objective: The aim of this study was to describe a protocol for systematic analysis and prioritization of feedback from user subgroups in the usability testing of a digital motivation support for fall-preventive physical activity (PA) interventions in seniors (aged 65 years and older). This protocol can help researchers and developers to systematically exploit feedback from relevant user subgroups in UCD. Methods: Gender, PA level, and level of technology experience have been identified in the literature to influence users’ experience and use of digital support systems for fall-preventive PA interventions in seniors. These 3 key user characteristics were dichotomized and used to define 8 (ie, 23) possible user subgroups. The presented method enables systematic tracking of the user subgroups’ contributions in iterative development. The method comprises (1) compilation of difficulties and deficiencies in the digital applications identified in usability testing, (2) clustering of the identified difficulties and deficiencies, and (3) prioritization of deficiencies to be rectified. Tracking user subgroup representation in the user feedback ensures that the development process is prioritized according to the needs of different subgroups. Mainly qualitative data collection methods are used. Results: A protocol was developed to ensure that feedback from users representing all possible variants of 3 selected key user characteristics (gender, PA level, and level of technology experience) is considered in the iterative usability testing of a digital support for seniors’ PA. The method was applied in iterative usability testing of two digital applications during spring/summer 2018. Results from the study on the users’ experiences and the iterative modification of the digital applications are expected to be published during 2021. Conclusions: Methods for systematic collection, analysis, and prioritization of feedback from user subgroups might be particularly important in heterogenous user groups (eg, seniors). This study can contribute to identifying and improving the understanding of potential differences between user subgroups of seniors in their use and experiences of digital support for fall-preventive PA interventions. This knowledge may be relevant for developing digital support systems that are appropriate, useful, and attractive to users and for enabling the design of digital support systems that target specific user subgroups (ie, tailoring of the support). The protocol needs to be further used and investigated in order to validate its potential value. 

  • 15.
    Revenäs, Åsa
    et al.
    Mälardalen University, School of Health, Care and Social Welfare, Health and Welfare. Centre for Clinical Research, Region Västmanland – Uppsala University, Västerås, Sweden; Orthopaedic clinic Västerås hospital, Region Västmanland, Västerås, Sweden.
    Ström, L.
    Livanda Internetkliniken AB, Ludvika, Sweden.
    Cicchetti, Antonio
    Mälardalen University, School of Innovation, Design and Engineering, Embedded Systems.
    Ehn, Maria
    Mälardalen University, School of Innovation, Design and Engineering, Embedded Systems.
    Toward digital inclusion of older adults in e-health: a case study on support for physical activity2023In: Universal Access in the Information Society, ISSN 1615-5289, E-ISSN 1615-5297Article in journal (Refereed)
    Abstract [en]

    Older adults are a heterogeneous population for which many e-health innovations are inaccessible. Involving older adults in user-centered design (UCD) with a specific focus on inclusive design is important to make e-health more accessible to this user group. This case study aimed to explore the feasibility of a new UCD approach aiming to minimize bias in the design phase of a digital support for older adults’ physical activity (PA). The study used mixed methods and applied UCD principles in a four-iteration design phase followed by an evaluation phase where 11 and 15 older adults participated, respectively. The users’ gender, PA level and technology experience (TE) were considered in recruitment, data analysis and prioritization of improvement efforts. In the design phase, users with different gender, PA level and TE participated and contributed with feedback, which was prioritized in the development. The adaptation included improving readability, simplifying layout and features, clarifying structure, and making the digital content more inclusive and relevant. The evaluation showed that the users had a positive experience of the prototype and could use it with some help. The study demonstrated that adopting e-health to assure digital inclusion among older adults must address several aspects. The UCD approach was feasible for amending user bias and for confirming that users of both genders and with varied PA- and TE level shaped the design. However, evaluation of the method with larger samples is needed. Moreover, further research on methods to involve digitally excluded populations in UCD is needed.

  • 16.
    Revenäs, Åsa
    et al.
    Mälardalen University, School of Health, Care and Social Welfare, Health and Welfare. Centre for Clinical Research, Region Västmanland – Uppsala University, Västerås, Sweden;Orthopedic Clinic Västerås Hospital, Region Västmanland, Västerås, Sweden.
    Ström, L.
    Livanda Internetkliniken AB, Ludvika, Sweden.
    Cicchetti, Antonio
    Mälardalen University, School of Innovation, Design and Engineering, Embedded Systems.
    Ehn, Maria
    Mälardalen University, School of Innovation, Design and Engineering, Embedded Systems.
    Towards multimodal boosting of motivation for fall-preventive physical activity in seniors: An iterative development evaluation study2023In: Digital Health, E-ISSN 2055-2076, Vol. 9, article id 20552076231180973Article in journal (Refereed)
    Abstract [en]

    Background

    Many seniors need to increase their physical activity (PA) and participation in fall prevention exercise. Therefore, digital systems have been developed to support fall-preventive PA. Most of them lack video coaching and PA monitoring, two functionalities that may be relevant for increasing PA.

    Objective

    To develop a prototype of a system to support seniors' fall-preventive PA, which includes also video coaching and PA monitoring, and to evaluate its feasibility and user experience.

    Methods

    A system prototype was conceived by integrating applications for step-monitoring, behavioural change support, personal calendar, video-coaching and a cloud service for data management and co-ordination. Its feasibility and user experience were evaluated in three consecutive test periods combined with technical development. In total, 11 seniors tested the system at home for four weeks with video coaching from health care professionals.

    Results

    Initially, the system's feasibility was non-satisfactory due to insufficient stability and usability. However, most problems could be addressed and amended. In the third (last) test period, both seniors and coaches experienced the system prototype to be fun, flexible and awareness-raising. Interestingly, the video coaching which made the system unique compared to similar systems was highly appreciated. Nonetheless, even the users in the last test period highlighted issues due to insufficient usability, stability and flexibility. Further improvements in these areas are needed.

    Conclusions

    Video coaching in fall-preventive PA can be valuable for both seniors and health care professionals. High reliability, usability and flexibility of systems supporting seniors are essential.

  • 17.
    Richardson, Matt
    et al.
    Mälardalen University, School of Health, Care and Social Welfare, Health and Welfare.
    Ehn, Maria
    Mälardalen University, School of Innovation, Design and Engineering, Embedded Systems. Malardalen Univ, Sch Innovat Design & Engn, Vasteras, Sweden..
    Landerdahl Stridsberg, Sara
    Malardalen Univ, Inst Lib, Vasteras, Sweden..
    Redekop, Kenneth
    Erasmus Univ, Rotterdam, Netherlands..
    Wamala, Sarah
    Mälardalen University, School of Health, Care and Social Welfare, Health and Welfare.
    Nocturnal digital surveillance in aged populations and its effects on health, welfare and social care provision: a systematic review2021In: BMC Health Services Research, E-ISSN 1472-6963, Vol. 21, no 1, article id 622Article in journal (Refereed)
    Abstract [en]

    Background Nocturnal digital surveillance technologies are being widely implemented as interventions for remotely monitoring elderly populations, and often replace person-based surveillance. Such interventions are often placed in care institutions or in the home, and monitored by qualified personnel or relatives, enabling more rapid and/or frequent assessment of the individual's need for assistance than through on-location visits. This systematic review summarized the effects of these surveillance technologies on health, welfare and social care provision outcomes in populations >= 50 years, compared to standard care. Method Primary studies published 2005-2020 that assessed these technologies were identified in 11 databases of peer-reviewed literature and numerous grey literature sources. Initial screening, full-text screening, and citation searching steps yielded the studies included in the review. The Risk of Bias and ROBINS-I tools were used for quality assessment of the included studies. Result Five studies out of 744 identified records met inclusion criteria. Health-related outcomes (e.g. accidents, 2 studies) and social care outcomes (e.g. staff burden, 4 studies) did not differ between interventions and standard care. Quality of life and affect showed improvement (1 study each), as did economic outcomes (1 study). The quality of studies was low however, with all studies possessing a high to critical risk of bias. Conclusions We found little evidence for the benefit of nocturnal digital surveillance interventions as compared to standard care in several key outcomes. Higher quality intervention studies should be prioritized in future research to provide more reliable evidence.

  • 18.
    Sjölinder, M.
    et al.
    SICS Swedish ICT, Kista, Sweden .
    Ehn, Maria
    Mälardalen University, School of Innovation, Design and Engineering, Embedded Systems.
    Boman, I. -L
    Department of Clinical Sciences, Karolinska Institute, Danderyd Hospital, Stockholm, Sweden .
    Folke, Mia
    Mälardalen University, School of Innovation, Design and Engineering, Embedded Systems.
    Hansson, P.
    SICS Swedish ICT, Kista, Sweden .
    Sommerfeld, D.
    Karolinska University Hospital, Department of Geriatric Medicine.
    Nylander, S.
    SICS Swedish ICT, Kista, Sweden .
    Borg, J.
    A multi-disciplinary approach in the development of a stroke rehabilitation tool2014In: Lecture Notes in Computer Science, vol. 8512, 2014, no PART 3, p. 351-362Conference paper (Refereed)
    Abstract [en]

    This work describes a method used in the development of a stroke rehabilitation tool. The method was based on three key elements. The first key element was iterations between the use of broad groups with different professionals/stakeholders and small hands-on working groups with users from the same profession. The second key element was movement between understanding differences between different organizations and professionals and understanding of specific needs within the different organizations. The final key element was including implementation aspects from the very start of the work.

  • 19.
    Wamala Andersson, Sarah
    et al.
    Mälardalen University, School of Health, Care and Social Welfare, Health and Welfare.
    Richardson, Matt
    Mälardalen University, School of Health, Care and Social Welfare, Health and Welfare.
    Landerdahl Stridsberg, Sara
    Mälardalen University.
    Ehn, Maria
    Mälardalen University, School of Innovation, Design and Engineering, Embedded Systems.
    Oklar effekt av digital nattillsyn2021In: Dagens arenaArticle in journal (Other (popular science, discussion, etc.))
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