BACKGROUND: Improving communication and information services for people receiving a total joint (knee or hip) arthroplasty (TJA) depends on the differences in patient communication needs and personal characteristics. PURPOSE: The purpose of this study was to further examine individual differences in TJA patient preferences regarding communication and information provision. METHODS: Nineteen patients participated in generative research, which meant they actively reflected on their TJA experiences and communication preferences through creative exercises (e.g., collage making). Audio transcripts of their shared reflections were qualitatively analyzed through an inductive approach. RESULTS: Some participants wanted detailed health education, others did not. Participants also reported different support needs (e.g., at hospital discharge or during rehabilitation). Moreover, participant preferences for social connections with care providers differed. CONCLUSIONS: An individual patient's mindset, his or her social support needs, physical condition, and medical history should guide the provision of tailored services.

@en

Adolescents and Young Adults (AYAs) with Cancer are making the transition from childhood to adulthood while handling the burden of cancer. During this extraordinarily challenging time in their growth and development, sexuality and intimacy, an important aspect of AYAs’ wellbeing, are often insufficiently addressed by the healthcare providers, and AYAs are dissatisfied with the available information. The objective of this study was to develop objectives that could help design properly address sexuality and intimacy in AYA care along with a design prototype. The research investigated the big picture of sexuality and intimacy care for AYAs in the Netherlands and looked into AYAs’ unmet needs through literature study, interviews with AYA using the Q-sort method and interviews with healthcare providers. The list of design objectives was proposed based on the interviewees’ opinions and insights, along with an iterative prototype designed by the researcher that reflected the objectives. Through a cyclic interview process, the list of design objectives was revised, and the prototype was refined as a possible solution in the end. Finally, a conclusion on the research findings and the design objectives is provided@en

For patients that undergo a total hip replacement (Total Hip Arthroplasty, THA), tailored communication through printed or digital information channels may improve the patient experience. This PhD project explored how a segmentation of the Total Joint Arthroplasty (TJA, both knee and hip surgery) patient population can be used to design tailored information tools for THA patients. The segmentation was established in another PhD project, and consisted of three patient profiles: An ‘Optimistic’ profile, showing limited coping strategies, lower communication needs and good preoperative clinical status; A ‘Managing’ profile with a diverse set of coping strategies, strong communication needs, and poor preoperative clinical status; and a ‘Modest’ profile, consisting of older people with higher anxiety and lower self-efficacy in communicating about health. First, the project explored individual preferences for information and communication among patients. It was concluded that in addition to the profiles, an individual patient’s mind-set (e.g. insecurity or anxiety regarding the surgery), and their social support needs, in combination with their physical condition and medical history, should guide the provision of tailored information and communication services. Subsequently, several prototypes were developed and evaluated with patients and care providers: Storyboards, paper-based prototypes, and a fully functional web application that informs THA patients about their activity levels after surgery. The final study explored the use and evaluation of the web application by different profiles. It was concluded that the profiles are an adequate segmentation that, combined with customized features, can be used to designing tailored information tools in THA. However, to increase the relevance of the tailored information, it should align with the course of recovery (e.g. post-surgery complications). Resolving generic technical and usability issues is also essential. The profile-specific design guidelines that resulted from this thesis can be used by creative industry and healthcare providers to tailor products and services for THA patients. They are also available online, at www.medisigntudelft.nl/research/patientprofiles.@en

Objective: Tailored communication and information provision is expected to contribute to patient-centred care (PCC) in total hip arthroplasty (THA). In previous research, three subgroups of THA patients were identified that are similar in their clinical, psychological and communication characteristics. Preliminary subgroup-specific design guidelines were also formulated.
Using these insights as a starting point, a theoretical framework was developed for tailored information provision and communication using digital applications. This study aims to refine the framework as well as subgroup-specific design
guidelines for digital applications.

Methods: This study uses a Research through Design (RtD) approach, generating insights both from the development and evaluation of prototypes in the early design stage. Paper-based prototypes will be made for each subgroup and evaluated with patients and care providers. Semi-structured interviews are held with participants exploring their experiences with the prototype. A quasi-experiment with a non-random control cohort is used to validate the qualitative findings. Post-surgery consultations with and without prototype are videotaped and scored using a structured instrument.

Results: A design diary will be used to summarize design decisions and considerations. Feedback from participants is analysed inductively. Adaptations in subgroup-specific guidelines will be based on comparison of verbal feedback and descriptive statistics from consultations with and without prototype.

Conclusions: Although mixed-method feasibility studies of digital health interventions are common, this protocol also considers the utility of the early design process and the designer’s perspective for realizing PCC and tailored care.@en

After a Total Hip Arthroplasty (THA), post-discharge contact moments with care providers may be scarce. Online resources may offer support, but Human Factors Engineering methods are needed to tailor these resources to patients’ varying post-surgery information needs. In order to evaluate tailored components in a web application and to refine guidelines for tailored Information Technology (IT) in healthcare, the authors developed a tailored web application for THA patients. The web application informs THA patients about recommended activity levels in the first months after surgery using individualized thresholds based on daily step counts. The feedback given by the application is designed in three variants that match characteristics from three different THA patient subgroups (profiles) defined in previous research. To investigate the use and evaluation of this application, a small-scale qualitative study (20 patients, 3 care providers) will be conducted. Results will include qualitative feedback from patients and care providers, as well as metrics describing participants’ use of the application. This paper discusses the study methodology, including the application used.

@en

Design research in healthcare can be demanding. We report on eight challenges that designers and design researchers face when working on healthcare projects. We conducted four workshops with design researchers active in healthcare: six PhD candidates, a mixed group of thirteen design researchers, twelve design students, and eight design practitioners. Participants shared critical events from recent projects and reflected collaboratively to identify common challenges across different design approaches or disciplines. An analysis of the workshop materials resulted in eight themes of challenges, divided into three clusters. The first cluster, challenges in practice, includes (1) conducting fieldwork, (2) involving end users, and (3) dealing with sensitive situations. The second cluster, managerial challenges, includes (4) managing relations, (5) building understanding, and (6) communicating value. Finally, in the third cluster, generic challenges, includes (7) attuning to time and financial restrictions and (8) establishing rapport. This overview can contribute to design education and practice by helping both novice and experienced designers recognize and anticipate potential hurdles when engaging with the complexities of the healthcare environment.@en

To achieve optimal patient-centered care for people undergoing a Total Hip Arthroplasty (THA), communication should ideally be tailored. In previous studies, three clusters of patients or patient ‘roles’ were identified based on communication preferences and clinical and psychological characteristics as a starting point for tailored communication in orthopedics. The current study aims to formulate initial guidelines for the design of tailored communication and information provision based on these roles. Two design cases were each evaluated as storyboards with twelve patients (three, seven, and two patients of each role, respectively). Generic and functionality-specific preferences were indicated by participants for both design proposals. Similarities in feedback per role provided the basis for generating an initial set of role-specific guidelines, that can be used to design tailored information and communication solutions.

@en

Background: Patients with orthopedic conditions frequently use the internet to find health information. Patient education that is distributed online may form an easily accessible, time- and cost-effective alternative to education delivered through traditional channels such as one-on-one consultations or booklets. However, no systematic evidence for the comparative effectiveness of Web-based educational interventions exists. Objective: The objective of this systematic review was to examine the effects of Web-based patient education interventions for adult orthopedic patients and to compare its effectiveness with generic health information websites and traditional forms of patient education. Methods: CINAHL, the Cochrane Library, EMBASE, MEDLINE, PsycINFO, PUBMED, ScienceDirect, Scopus, and Web of Science were searched covering the period from 1995 to 2016. Peer-reviewed English and Dutch studies were included if they delivered patient education via the internet to the adult orthopedic population and assessed its effects in a controlled or observational trial. Results: A total of 10 trials reported in 14 studies involving 4172 patients were identified. Nine trials provided evidence for increased patients' knowledge after Web-based patient education. Seven trials reported increased satisfaction and good evaluations of Web-based patient education. No compelling evidence exists for an effect of Web-based patient education on anxiety, health attitudes and behavior, or clinical outcomes. Conclusions: Web-based patient education may be offered as a time- and cost-effective alternative to current educational interventions when the objective is to improve patients' knowledge and satisfaction. However, these findings may not be representative for the whole orthopedic patient population as most trials included considerably younger, higher-educated, and internet-savvy participants only.

@en