Background Digital health (DH) brings considerable benefits, but it comes with potential risks. Human Factors (HF) play a critical role in providing high-quality and acceptable DH solutions. Consultation with designers is crucial for reflecting on and improving current DH design practices. Objectives We investigated the general DH design processes, challenges, and corresponding strategies that can improve the digital patient experience (PEx). Methods A semi-structured interview study with 24 design professionals. All audio recordings were transcribed, deidentified, grammatically corrected, and imported into ATLAS.ti for data analysis. Three coders participated in data coding following the thematic analysis approach. Results We identified eight DH design stages and grouped them into four phases: preparation, problem-thinking, problem-solving, and implementation. The analysis presented twelve design challenges associated with contextual, practical, managerial, and commercial aspects that can hinder the design process. We identified eight common strategies used by respondents to tackle these challenges. Conclusions We propose a Digital Health Design (DHD) framework to improve the digital PEx. It provides an overview of design deliverables, activities, stakeholders, challenges, and corresponding strategies for each design stage.@en

Studies on finger kinematics, especially the range of motion (RoM) measurements, are essential to understand the use of finger joints and the pathology of related disease. Limited literatures compared the active RoM (A-RoM) of finger joints with either their functional RoM (F-RoM) or passive RoM (p-RoM) using different measuring protocols and tools. This study aims to provide an overall comparison including all three types of RoMs. We measured A-RoM, F-RoM, and P-RoM, using a dynamic measurement system. Our goal is to investigate the relationships among the three RoMs by comparing their extreme rotation angles. The results suggested that P-RoM was the largest motion range, and F-RoM can exceed their A-RoM. The F-RoM of distal-interphalangeal joints may rotated 8–20° more than their A-RoM, mainly during precise and power manipulations. Besides to A-RoM, knowledge of F-RoM and P-RoM are also important for a comprehensive understanding for clinical practice, and thus, to support the optimization and evaluation of treatment devices for finger joint, such as implant replacement.

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BACKGROUND: The increasing prevalence of DH applications has outpaced research and practice in digital health (DH) evaluations. Patient experience (PEx) was reported as one of the challenges facing the health system by the World Health Organization. To generate evidence on DH and promote the appropriate integration and use of technologies, a standard evaluation of PEx in DH is required. OBJECTIVE: This study aims to systematically identify evaluation timing considerations (ie, when to measure), evaluation indicators (ie, what to measure), and evaluation approaches (ie, how to measure) with regard to digital PEx. The overall aim of this study is to generate an evaluation guide for further improving digital PEx evaluation. METHODS: This is a 2-phase study parallel to our previous study. In phase 1, literature reviews related to PEx in DH were systematically searched from Scopus, PubMed, and Web of Science databases. Two independent raters conducted 2 rounds of paper screening, including title and abstract screening and full-text screening, and assessed the interrater reliability for 20% (round 1: 23/115 and round 2: 12/58) random samples using the Fleiss-Cohen coefficient (round 1: k1=0.88 and round 2: k2=0.80). When reaching interrater reliability (k>0.60), TW conducted the rest of the screening process, leaving any uncertainties for group discussions. Overall, 38% (45/119) of the articles were considered eligible for further thematic analysis. In phase 2, to check if there were any meaningful novel insights that would change our conclusions, we performed an updated literature search in which we collected 294 newly published reviews, of which 102 (34.7%) were identified as eligible articles. We considered them to have no important changes to our original results on the research objectives. Therefore, they were not integrated into the synthesis of this review and were used as supplementary materials. RESULTS: Our review highlights 5 typical evaluation objectives that serve 5 stakeholder groups separately. We identified a set of key evaluation timing considerations and classified them into 3 categories: intervention maturity stages, timing of the evaluation, and timing of data collection. Information on evaluation indicators of digital PEx was identified and summarized into 3 categories (intervention outputs, patient outcomes, and health care system impact), 9 themes, and 22 subthemes. A set of evaluation theories, common study designs, data collection methods and instruments, and data analysis approaches was captured, which can be used or adapted to evaluate digital PEx. CONCLUSIONS: Our findings enabled us to generate an evaluation guide to help DH intervention researchers, designers, developers, and program evaluators evaluate digital PEx. Finally, we propose 6 directions for encouraging further digital PEx evaluation research and practice to address the challenge of poor PEx.

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Design is expanding its influence on shaping future healthcare. Ideally, designers apply human-centered design and human factors that introduce theory, principles, and methods to design to optimize people’s healthcare experiences in both digital and non-digital environments. To discuss and implement experience design in healthcare, consensus about experience design in healthcare is needed. Objectives: Therefore, the purpose of this study is to investigate designers’ views on experience design in health, and to uncover their understanding about three experience design concepts, i.e., user experience (UX), patient experience (PEx), and digital patient experience (dPEx). We conducted online semi-structured interviews study with convenience samples who met the eligibility. We used ATLAS.ti for an in-depth data coding following thematic analysis. 24 international designers of digital health solutions, either in industry or in academia took part in the interviews. We found the similarities and differences mentioned between healthcare design and non-healthcare design relate to (1) design principles, (2) user attributes, and (3) design contexts. Furthermore, the differences between UX, PEx, and dPEx can be mapped on five dimensions: people, contexts, purposes, means, and usage scenarios. These insights can help designers and human factors specialists build a common design language for experience design in healthcare. Our study can also assist designers and human factors specialists with experience design in digital health by pointing out the areas where design thinking generally is appropriate and the places where particular expertise in healthcare design is needed.

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Subjective scales are frequently used in the design process of head-related products to assess pressure discomfort. Nevertheless, some users lack fundamental cognitive and motor abilities (e.g., paralyzed patients). Therefore, it is vital to find non-verbal measurements of pressure discomfort and pressure pain. This study gathered the autonomic response data (heart rate and skin conductance) of 30 landmarks in head, neck and face from 31 participants experiencing pressure discomfort and pressure pain. The results indicate that pressure stimulation can change heart rate (HR) and skin conductance (SC). SC can be more useful in assessing pressure discomfort than HR for specific landmarks, and SC also possesses a faster arousal rate than HR. Moreover, HR decreased in response to pressure stimulation, while SC decreased followed by an increase. In comparisons between genders, the subjective pressure discomfort threshold (PDT) and pressure pain threshold (PPT) of women were lower than those of men, but men's autonomic responses (HR and SC) were more intense. Furthermore, there was no linear correlation between subjective pressure thresholds (PDT and PPT) and autonomic response intensity. This study has significant implications for resolving ergonomic issues (pressure discomfort and pain) associated with head-related products.@en

Pressure sensitivity research on the head, face, and neck is critical to develop ways to reduce discomfort caused by pressure in head-related products. The aim of this paper is to provide information for designers to be able to reduce the pressure discomfort by studying the relation between pressure sensitivity and soft tissue in the head, face and neck. We collected pressure discomfort threshold (PDT) and pressure pain threshold (PPT) from 119 landmarks (unilateral) for 36 Chinese subjects. Moreover, soft tissue thickness data on the head, face and neck regions of 50 Chinese people was obtained through CT scanning while tissue deformation data under the PDT and PPT states was obtained from literature. The results of the three-elements correlation analysis revealed that soft tissue thickness is positively correlated with deformation but not an important factor in pressure sensitivity. Our high-precision pressure sensitivity maps confirm earlier findings of more rough pressure sensitivity studies, while also revealing additional fine scale sensitivity differences. Finally, based on the findings, a high-precision "recommended map” of the optimal stress-bearing area of the head, face and neck was generated.

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Temporal binding refers to a systemic bias in the perceived time interval between two related events, most frequently voluntary motor actions and a subsequent sensory effect. An inevitable component of most instrumental motor actions is tactile feedback. Yet, the role of tactile feedback within this phenomenon remains largely unexplored. Here, we used local anesthesia of the index finger to temporarily inhibit incoming sensory input from the finger itself, while participants performed an interval-estimation task in which they estimated the delay between a voluntary motor action (button press) and a second sensory event (click sound). Results were compared to a control condition with intact sensation. While clear binding was present in both conditions, the effect was significantly enhanced when tactile feedback was temporarily removed via local anesthesia. The results are discussed in light of current debates surrounding the underlying mechanisms and function of this temporal bias.

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In hospitals, sinks act as reservoirs for bacterial pathogens. To assess the extent of splashing, fluorescein dye was added to four hospital sinks previously involved in pathogen dispersal to the environment and/or transmission to patients, and one sink that was not. Applying dye to the p-trap or tailpiece did not result in any fluorescent droplets outside of the drain. When applied to the drain, droplets were found in all but one wash basin, and this was more common in the absence of a drain plug. Sink design considerations to install drain plugs, reduce dripping and offset the tap may help to prevent transmission from drains.

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This study measured the active range of motion (AROM) and functional range of motion (FROM) of finger joints and explored the relationships between them. The results revealed that the AROM cannot fully cover the FROM in some scenarios with force. @en

Measuring the motions of human hand joints is often a challenge due to the high number of degrees-of-freedom. In this study, we proposed a hand tracking system utilizing action cameras and ArUco markers to continuously measure the rotation angles of hand joints during motion. Three methods were developed to estimate the joint rotation angles. The pos-based method transforms marker positions to a reference coordinate system and extracts a hand skeleton to identify the rotation angles. Similarly, the orient-x-based method calculates the rotation angles from the transformed x-orientations of the detected markers in the reference coordinate system. In contrast, the orient-mat-based method first identifies the rotation angles in each camera coordinate system using the detected orientations and then synthesizes the results regarding each joint. Experiment results indicated that the repeatability errors with one camera regarding different marker sizes were around 2.64–27.56 deg and 0.60–2.36 deg using the marker positions and orientations, respectively. With multiple cameras employed, the joint rotation angles measured by using the three methods were compared with that measured by a goniometer. Comparison results indicated that the results of using the orient-mat-based method are more stable and efficient and can describe more types of movements. The effectiveness of this method was further verified by capturing hand movements of several participants. Therefore, it is recommended for measuring joint rotation angles in practical setups.@en

Since Covid-19, digital health interventions (DHIs) have been embraced as never before. The pandemic led to many new challenges, including the patient experience in digital health care delivery. In this literature study, we identified and synthesized factors that impact patient experience in digital health (dPEx), and reviewed the methods and strategies relevant to its design and implementation. We conducted an umbrella review including 15 reviews representing 543 studies. Four themes were identified that describe design-relevant factors that impact dPEx: individual context, content, technical issues, and design features. We propose a preliminary framework to explain the relationship between each factor and support user-centered design efforts. Further research is needed to identify which factors have the most impact.

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Analysing the contact area between head-related products and the corresponding craniofacial profile is necessary to make such products more comfortable. The study of soft tissue biomechanical experiments provides a reliable perspective for understanding such contact areas and improving the comfort. In order to obtain more accurate and visualized craniofacial biological information that can be used to guide product design, CT data of the head, face, and neck of 50 Chinese aged 18-35 years were obtained in this paper. For each subject, an individual thickness map is calculated by segmentation of the soft tissue layer and wall-thickness calculation via Mimics. The individual maps superimposed on the outer surface area of the head, face, and neck are brought into correspondence using a non-rigid iterative closest point technique. From the correspondence an average head, face, and neck geometry and soft tissue thickness map was calculated. Statistics of the overall soft tissue thickness of the head, face, and neck is extracted, and an accurate soft tissue thickness map of the Chinese head, face, and neck is generated. This study not only lays the groundwork for future simulation experiments on head-related product design, but it also has significant implications for the fields of facial reconstruction in China.@en

Background: The adoption and use of technology have significantly changed health care delivery. Patient experience has become a significant factor in the entire spectrum of patient-centered health care delivery. Digital health facilitates further improvement and empowerment of patient experiences. Therefore, the design of digital health is served by insights into the barriers to and facilitators of digital patient experience (PEx). Objective: This study aimed to systematically review the influencing factors and design considerations of PEx in digital health from the literature and generate design guidelines for further improvement of PEx in digital health. Methods: We performed an umbrella systematic review following the PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) methodology. We searched Scopus, PubMed, and Web of Science databases. Two rounds of small random sampling (20%) were independently reviewed by 2 reviewers who evaluated the eligibility of the articles against the selection criteria. Two-round interrater reliability was assessed using the Fleiss-Cohen coefficient (k1=0.88 and k2=0.80). Thematic analysis was applied to analyze the extracted data based on a small set of a priori categories. Results: The search yielded 173 records, of which 45 (26%) were selected for data analysis. Findings and conclusions showed a great diversity; most studies presented a set of themes (19/45, 42%) or descriptive information only (16/45, 36%). The digital PEx-related influencing factors were classified into 9 categories: patient capability, patient opportunity, patient motivation, intervention technology, intervention functionality, intervention interaction design, organizational environment, physical environment, and social environment. These can have three types of impacts: positive, negative, or double edged. We captured 4 design constructs (personalization, information, navigation, and visualization) and 3 design methods (human-centered or user-centered design, co-design or participatory design, and inclusive design) as design considerations. Conclusions: We propose the following definition for digital PEx: "Digital patient experience is the sum of all interactions affected by a patient's behavioral determinants, framed by digital technologies, and shaped by organizational culture, that influence patient perceptions across the continuum of care channeling digital health." In this study, we constructed a design and evaluation framework that contains 4 phases-define design, define evaluation, design ideation, and design evaluation-and 9 design guidelines to help digital health designers and developers address digital PEx throughout the entire design process. Finally, our review suggests 6 directions for future digital PEx-related research.

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Human-centered design is about understanding human needs and how design can respond to these needs. With its systemic humane approach and creativity, human-centered design can play an essential role in dealing with today's care challenges. 'Design' refers to both the process of designing and the outcome of that process, which includes physical products, services, procedures, strategies and policies. In this article, we address the three key characteristics of human-centered design, focusing on its implementation in health care: (1) developing an understanding of people and their needs; (2) engaging stakeholders from early on and throughout the design process; (3) adopting a systems approach by systematically addressing interactions between the micro-, meso- and macro-levels of sociotechnical care systems, and the transition from individual interests to collective interests.

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The macroergonomics perspective on patient work emphasizes that work performed by patients and their informal caregivers is performed in a work system that has multiple elements (people, tasks, technologies, and physical, social and organizational environment). Patient work is done at multiple system levels of direct care level, organizational level and policy level. Various macroergonomic models of patient work have been developed that can be used to describe and
evaluate the broad sociotechnical system in which patient work occurs. These models can be used to improve the design and implementation of sociotechnical interventions such as patient portal and decision support technologies. Because patient work occurs over time and space, we recommend the approach of mapping the patient journey, which can be applied to improve thepatient work system and outcomes, including outcomes of importance to patients, e.g. their
experience with health care delivery organizations.@en

Measuring the motion of human hand joints is a challenging task due to the high number of DOFs. In this study, we proposed a low-cost hand tracking system built on action cameras and ArUco markers to measure finger joint rotation angles. The lens distortion of each camera was corrected first via intra-calibration and the videos of different cameras were aligned to the reference camera using a dynamic time warping based method. Two methods were proposed and implemented for extracting the rotation angles of finger joints: one is based on the 3D positions of the markers via inter-calibration between cameras, named pos-based method; the other one is based on the relative marker orientation information from individual cameras, named rot-based method. An experiment was conducted to evaluate the effectiveness of the proposed system. The right hand of a volunteer was included in this practical study, where the movement of the fingers was recorded and the finger rotation angles were calculated with the two proposed methods, respectively. The results indicated that although using the rot-based method may collect less data than using the pos-based method, it was more stable and reliable. Therefore, the rot-based method is recommended for measuring finger joint rotation in practical setups.

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While there has been increasing interest in the use of gamification in mental health care, there is a lack of design knowledge on how elements from games could be integrated into existing therapeutic treatment activities in a manner that is balanced and effective. To help address this issue, we propose a design process framework to support the development of mental health gamification. Based on the concept of experienced game versus therapy worlds, we highlight 4 different therapeutic components that could be gamified to increase user engagement. By means of a Dual-Loop model, designers can balance the therapeutic and game design components and design the core elements of a mental health care gamification. To support the proposed framework, 4 cases of game design in mental health care (eg, therapeutic protocols for addiction, anxiety, and low self-esteem) are presented.

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To support developing new playful product for older adults, this paper briefly reviewed a range of existing playful products, and describes how they could be strategically deconstructed and refactored from the perspective of the five interaction elements (person, purpose, means, contexts, and actions). A design framework combining case analogies and persona methods was proposed. The formalized design strategy of persona and case-based interaction elements analysis system that mainly considers two parts in the design process which are called ‘inspiration cases’ and ‘typical users’ in this paper. The strategy can be applied to the process of re-designing a specific class of playful products, such as tangible toys or digital games, for particular older adults.

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The use of 3D anthropometric data of children’s heads and faces has great potential in the development of protective gear and medical products that need to provide a close fit in order to function well. Given the lack of detailed data of this kind, the aim of this study is to map the size and shape variation of Dutch children’s heads and faces and investigate possible implications for the design of a ventilation mask. In this study, a dataset of heads and faces of 303 Dutch children aged six months to seven years consisting of traditional measurements and 3D scans were analysed. A principal component analysis (PCA) of facial measurements was performed to map the variation of the children’s face shapes. The first principal component describes the overall size, whilst the second principal component captures the more width related variation of the face. After establishing a homology between the 3D scanned face shapes, a second principal component analysis was done on the point coordinates, revealing the most prominent variations in 3D shape within the sample.

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