JMIR Human Factors

Expert Views on Criteria for Evaluation of Human Factors Methods: Qualitative Interview Study

2026-02-03T16:30:09-05:00

Background: Human factors (HF) or ergonomics, which explores the interaction between humans and systems, has been used to support design in safety critical industries such as aviation, transportation, nuclear power and manufacturing. HF methods have the potential to support the safe design of health information technology (HIT) however the evaluation of HF methods to determine their effectiveness and feasibility in this context has been limited. Objective: The aim of this study was to identify criteria for evaluating HF methods when applied to real world projects and use these to propose a framework for method evaluation. Methods: HF practitioners were recruited via a purposive sampling method in conjunction with snowball sampling and invited to participate in a semi-structured interview to discuss HF methods and how they should be evaluated. Results were reviewed and thematically analysed. Results: A total of 21 participants took part, and interviews lasted on average 52 minutes (range 39 – 103 minutes). Participants explained that they did not routinely evaluate methods, however they outlined a range of criteria to support method evaluation. Overall, 5 criteria and 28 sub-criteria were identified. High level criteria included effectiveness, efficiency, ease of use and acceptability, and impact on the solution. Conclusions: Results from this study have been used to propose a framework for evaluating HF methods used in real world HIT projects. The framework could provide organisations with valuable information on how to optimise the application and outcomes of HF methods, and build HF capability within organisations particularly where this may be lacking. Clinical Trial: N/A

Navigation, Adoption, and Use of Digital Health Technologies for Irritable Bowel Syndrome Self-Management: Focus Group Study of Patient Experience and Decision-Making

2026-02-02T13:00:25-05:00

Background: Irritable bowel syndrome (IBS) is a common chronic gastrointestinal disorder that impairs bowel functions and patients’ overall quality of life. IBS-focused digital health technologies (DHTs), including online health resources and mobile health (mHealth) apps, have recently proliferated for patient use. However, research exploring patients’ experiences with navigating, adopting, or using commercial or publicly available DHTs for IBS self-management is limited. Objective: This study aims to explore the user experiences and decision-making of patients with IBS as they navigate, adopt, and use diverse DHTs for disease self-management. Methods: We conducted virtual semistructured focus group interviews to explore the experiences of patients with IBS using DHTs, including their perspectives on design and features, their decision-making process in using DHTs, and recommendations for improving user experience and uptake, given the heterogeneous nature of these tools. Canada-based patients with IBS who were using or had used mHealth apps to manage symptoms were recruited through purposive sampling from previous IBS-related studies. Discussions were transcribed verbatim, and inductive thematic analysis was performed using NVivo (version 14; Lumivero). A modified version of the Expanded Unified Theory of Acceptance and Use of Technology (UTAUT2) model was applied to guide the interpretation of the dynamic relationship between the influences on participants’ decisions regarding DHT use. Results: Among the 8 participants (all female; mean age 55.3, SD 13.5 years), two themes were identified: (1) uncertainty impacts the trustworthiness of DHTs, and (2) influences that drive the decision-making process to adopt and use DHTs. The observed influences aligned with the constructs of the UTAUT2 model (performance expectancy, effort expectancy, social influence, facilitating conditions, hedonic motivation, price value, and habit), with the addition of trust and risk in participants’ decision-making. Digital health literacy and patient engagement were also raised as crucial components of participants’ experiences and perspectives on DHTs. Conclusions: Findings of this study highlight the current landscape of digital health in IBS and existing gaps and challenges for patients in navigating, adopting, and using DHTs for IBS self-management. While DHTs were generally viewed positively for their value and potential, patients with IBS consider several coexisting factors and trade-offs in their decision-making. Further investigations on the influences on and perspectives toward DHTs could enhance future development and iterations of these tools and improve patient confidence and uptake.

Online Tiered Screening for Mental Health Problems Among Refugees in Sweden: Validation Study

2026-01-29T17:30:45-05:00

Background: Refugees and asylum-seekers commonly experience numerous adverse and traumatic events and are therefore at increased risk of mental health problems. Despite the high need for mental health interventions, services tend to be underused by refugees and asylum-seekers, and various barriers compromise access. Digital, efficient screening, adapted for these groups, could facilitate initial assessment and increase accessibility to mental health services. We developed an internet-based tiered screening procedure (i-TAP) aiming to identify clinically relevant symptoms of major depressive disorder (MDD), anxiety disorder, posttraumatic stress disorder, and insomnia disorder among individuals with a refugee background. The i-TAP is an adaptive procedure with 3 tiers aiming to identify general mental distress in Tier 1, differentiate between symptoms in Tier 2, and assess the severity of symptoms in Tier 3. Each tier additionally functions as a gateway to further assessment, as a negative outcome terminates the procedure. Objective: The purpose of this study was to evaluate the diagnostic test accuracy of the i-TAP, using structured clinical assessments as the reference standard. Methods: In this prospective study, 70 adult participants with a refugee background, literate in Arabic, Dari, Farsi, or Swedish, and residing in Sweden, completed the i-TAP on tablets and participated in a subsequent structured diagnostic interview. Results: It has been shown that the i-TAP could identify 91.7% (33/36) of individuals assessed with any psychiatric disorder, and correctly identified 82.1% of all positive cases of MDD, anxiety disorder, posttraumatic stress disorder, and insomnia disorder, with few false negative assessments. Overall test accuracy of the i-TAP ranged between 77.1% and 84.3%, depending on disorder. The tiered design could reduce item burden while maintaining accuracy. A vast majority of participants rated the user experience as positive. In this sample, 36/70 (51.4%) individuals were assessed with one or more psychiatric disorders and comorbidity was high. Conclusions: The i-TAP may be a valid, efficient, and feasible screening tool for the identification of common psychiatric disorders among individuals with a refugee background in Sweden. The i-TAP could be implemented as a first screener in various settings, including online and in-person clinical practices. The digital, adaptive, multilingual format could facilitate early assessment and increase the availability of mental health services for refugees and asylum-seekers.

Exploring Medical Information Needs and Accessibility in Swedish Dental Care by Analysis of Documentation Workflows and Electronic Dental Records in Dalarna: Sociotechnical Qualitative Study

2026-01-29T17:00:14-05:00

Background: Despite growing evidence demonstrating the connection between oral and systemic health, medical and dental care remain institutionally divided. A significant consequence of this division is the lack of information sharing, which is particularly problematic in dental care, where knowing patients’ medical information is crucial for providing safe and effective treatments. This separation poses additional challenges in Swedish regions with limited resources, such as Dalarna, where dental care practices would benefit from improved access to relevant medical information in their Electronic Dental Record systems. Objective: This study aimed to explore how current documentation workflows and Electronic Dental Record systems support the medical information needs within dental care practices in Dalarna and consider what influence direct access to medical information could have. Methods: The study adopted an exploratory-descriptive qualitative approach. Semi-structured interviews were conducted with dental practitioners working in General Dental Practices. Data collection followed a sociotechnical framework, and thematic analysis was performed to identify key medical information needs, as well as current workflow and system limitations. Conceptual models were developed to reflect these findings. Results: Eighteen dental practitioners were interviewed. The identified medical information needs included specific types of medical conditions, pharmacological information, treatment history, and laboratory values. Furthermore, dental practitioners highlighted substantial challenges in existing documentation workflows and the Electronic Dental Record system. Proposed conceptual models demonstrated how integrating Electronic Dental Record systems with the Swedish National Patient Overview (“Nationell Patientöversikt”) via National Service Platform (“Nationell Tjänsteplattform”) could streamline workflows and enhance information accessibility. Conclusions: The findings show a clear need to improve medical information accessibility in dental care. A solution is to facilitate interoperability and align digital infrastructure with the identified needs. The proposed recommendations offer a feasible starting point for improving medical information access in Swedish dental care, particularly in resource-constrained regions like Dalarna.

Demystifying Quality Metrics and Unveiling the True Measure of Quality of Care in Nursing Homes: Mixed Effects Analysis

2026-01-29T16:45:09-05:00

Background: Over the years, the nursing home regulatory landscape has undergone considerable transformation. The Five-Star Quality Rating System for Nursing Homes plays a central role in evaluating Quality of Care (QoC), though it carries both strengths and limitations. This system relies heavily on the Minimum Data Set (MDS) and derives several Quality Measures (QMs) from it. In this study, we validated the effectiveness of the Five-Star Nursing Homes Quality Rating System and its underlying quality measures in estimating nursing home quality of care. We constructed a panel dataset from three major sources: 1) COVID-19 nursing home data, 2) Payroll-Based Journal (PBJ) data, and 3) nursing home quality measure snapshots. The outcome variables included resident and staff cases, as well as death counts during the period May 2020–June 2023. The predictor variables were the Five-Star Quality Rating System for Nursing Home and its underlying QMs classified as either Structure, Process, or Outcome (SPO) QMs. The dataset included all nursing homes that completed at least one week of COVID-19 reporting at the facility level (N = 15,416) during the study period. Objective: In this study, we evaluate the effectiveness of nursing home Quality Measures (QMs) in explaining nursing home quality of care in terms of COVID-19 health outcomes. We achieve this by regressing COVID-19 outcomes measured in the U.S. nursing homes during the period May 2020 - June 2023 on nursing home QMs, classified using the Donabedian Structure-Process-Outcome (SPO) framework, which are used in constructing the Five-Star Quality Rating System for Nursing Home. We hypothesized that nursing homes with better structural quality (greater staff availability, better skill mix, etc.), better process quality (lower restraint use, higher vaccination rates, etc.), and better outcome quality (lower number of residents with pressure ulcers, lower number of resident falls, etc.) experienced better COVID-19 performance in terms of resident and staff infections and deaths. Methods: We used hierarchical generalized linear mixed-effects modeling to examine the association between the COVID-19 outcomes and SPO quality measures. Missing values in the dataset were imputed using random forest. Subsequently, we modeled the COVID-19 outcomes and the SPO quality measures using hurdle/truncated zero-inflated negative binomial (ZINB) mixed-effects models. The zero-inflation (ZI) model included factors influencing initial susceptibility to COVID-19 for the COVID-19 case outcomes and factors influencing the possibility of death after COVID-19 had been contracted for the COVID-19 death outcome. The model estimates were conditioned on ZI and random effects (RE). Results: Staffing measures (p < .001 for all variables in all models), health deficiency scores (p < .001 for all variables in at least one model), COVID-19 hospitalizations (p < .001 for all variables in at least two models), and vaccinations (p < .001 for all variables in at least two models) exhibited meaningful relationships with the COVID-19 outcomes. The Five-Star Nursing Homes Quality Rating System, Medicaid Dependency, and Ownership showed no clear relationships with the COVID-19 outcomes. Conclusions: Although widely used in the nursing home industry, the Five-Star Quality Rating System for Nursing Homes is an unreliable performance measure. Concerted efforts from lawmakers, policymakers, and lobbyists will be required to refine and enhance the measure, thereby ensuring its reliability and effectiveness.

Parental Influence on Children’s Media Use in South Korea: National Population-Based Study

2026-01-28T16:00:13-05:00

Background: To better understand the effects of media use on children, it is essential to examine the various factors influencing the media use of digital native children. In the situational context, parental media usage, parents’ attitudes toward media, and parenting styles have all been identified as significant factors influencing children’s media use. This study focuses on the key factors and examines these relationships in greater depth, drawing on existing research to understand their impact on the media usage patterns of digital native children. Objective: This study examines the relationship between parental influences and young children’s media use in Korea over three years (2022–2024). Methods: Using multigroup structural equation modeling, we investigated how parental media habits, attitudes, and distinct parenting styles predict children’s daytime and nighttime media consumption. Results: Online survey results (n2022 = 1,058, n2023 = 1,020, and n2024 = 1,020) revealed that parental media time, particularly for mothers, consistently correlated with higher levels of children's daytime media use (β =.002~.003). Positive parental attitudes toward media increased children’s daytime media use (β=.028~.102), whereas negative attitudes had a limited effect(β=-.069~.140). Among the seven parenting styles, positive parenting consistently reduced children’s daytime media use in 2022 and 2023 (β=-.228 for 2022, β=-.215 for 2023), but harsh punishment emerged as the strongest factor in daytime media use in 2024 (β=-.078 for 2022, β=-.090 for 2023, and β=-.072 for 2024). Notably, parenting styles showed no significant effect on children’s nighttime media use throughout the study, suggesting that parental influence may be more effective during daytime hours. Conclusions: This analysis extends existing research by differentiating media use patterns across time periods and highlights the evolving influence of parenting styles. These findings have implications for the development of targeted parental guidelines for managing young children’s media exposure, especially as digital media continues to become a pervasive part of daily life.

Objective Monitoring of Tablet Use–Related Optical Exposure and Its Association With Axial Length in Preschool Children: Cross-Sectional Intelligent Monitoring Study

2026-01-28T15:15:07-05:00

Background: In recent years, the global prevalence of myopia among children has continued to rise. The preschool years represent a critical period for visual development, and the widespread adoption of electronic screens among young children has brought increasing attention to pediatric visual health. However, the association between visual environmental exposures related to screen use—such as screen brightness and ambient illuminance—and the risk of myopia in preschool children has not been thoroughly investigated. Objective: This monitoring study aimed to investigate the association between electronic screen brightness, ambient illuminance, and axial length in preschool children, so as to provide evidence-based support for developing screen brightness usage recommendations for this population. Methods: This cross-sectional monitoring study was conducted between March and July 2023 in Shanghai, China, involving two representative samples of kindergarten children aged 3 to 6 years. Each participant was provided with a tablet pre-installed with intelligent monitoring software, which continuously and objectively recorded real-time data on screen time and screen brightness over a consecutive seven-day period. In addition, comprehensive data collection encompassed standardized ophthalmic assessments, high-precision ambient illuminance measurements, simulated laboratory lighting evaluations, and parental questionnaires. Associations between ambient illuminance, screen brightness, and axial length were analyzed using multivariable linear regression and restricted cubic spline models. Results: Of the 199 children included in the total sample, 124 were boys (62.3%), and 75 were girls (37.7%). After adjustment for demographic characteristics, parental myopia, and screen use behaviors,the median ambient illuminance during tablet use was significantly inversely associated with axial length (β= -.13, 95% CI: -0.22 to -0.04, P = .006). A nonlinear dose-response relationship was identified between median screen brightness and axial length (Pnon-linearity=.004), with axial elongation accelerating beyond approximately 27 cd/m²and peaking around 56 cd/m². Boys ( P < .001)and greater height (P=.33) were also significantly associated with longer axial length. Conclusions: Higher ambient illuminance during tablet use is associated with shorter axial length in preschoolers, while screen brightness exhibits a nonlinear effect on axial elongation. This study shows the importance of optimizing both environmental lighting and device settings to protect visual health in young children, providing empirical support for guidelines on safe digital device use and ambient lighting conditions in early childhood.

Redesign of Bedside Supply Carts to Improve Emergency Department Workflows: Mixed Methods Participatory Design

2026-01-28T11:00:04-05:00

Background: Emergency departments are often chaotic environments where delays can significantly impact patient care. Key items are stored in supply carts in or near patient rooms to promote efficiency and enable nurses to spend more time assisting patients. However, disorganization, lack of standardization, and lack of stocking can cause significant delays and negatively impact quality of care. Objective: This study utilized human-centered and participatory design to improve the workflow for supply acquisition in an emergency department. Methods: Using a mixed-methods, participatory design approach following the Double Diamond framework, the team worked with nursing staff and physicians in an urban emergency department to understand the root causes of frustrations with the current supply carts. Qualitative findings about bedside nursing workflows were integrated with quantitative observations of inventory and supply usage to drive a rapid-cycle prototyping process to optimize supply management in the bedside cart. Results: A lack of clinical staffing exacerbates preexisting challenges with restocking the medical supplies in the bedside carts. This problem is compounded by misallocation of supplies, with high-frequency items underrepresented and low-frequency items overrepresented in the bedside carts. This leads to wastage of the seldom-used supplies, and lack of access to the most used supplies. Reorganization of the cart through co-design with nursing staff sped up supply acquisition by approximately 20% overall, tripled the availability of the most important supplies, and reduced the need for restocking from once per shift to once per three shifts, thus producing tangible improvements even within institutional limitations. Conclusions: A participatory design process, using human factors principles in tandem with extensive input from end-users, enables improvements to stocking. Implications for Practice:  Lack of easy access to appropriate supplies negatively impacts patient care and contributes to nurse burnout and frustration.  Human factors engineering can improve access to patient care supplies through redesigning the layout of hospital supply carts to better align with workflows.  Co-design with frequent collaboration from stakeholders and end-users ensures that solutions address the issues that matter most in a sustainable way.

Acceptability of a Digital Care App in Patients Undergoing Hip and Knee Arthroplasty: Prospective Cohort Study

2026-01-27T16:30:08-05:00

Background: Mobile health (mHealth) applications have become more common in healthcare, including in orthopaedics. However, for these mHealth apps to be efficient, patients should be willing to use them. Objective: This study evaluated the acceptability of using an mHealth app for post-operative care following total hip and knee arthroplasty. Methods: This pre-operative cohort study with 100 patients measured acceptability using the theoretical framework for acceptability (TFA) pre-operatively and at three months post-operation. We also measured satisfaction with app usage post-operatively using the USE questionnaire as well as PROMs pre-operatively and post-operatively using the Oxford hip and knee scores and the VAS. Patients included were 18 or older, underwent unilateral primary total hip, total knee or partial knee arthroplasty, spoke and read French or English and had a smartphone with Internet access. Participants used mymobility® (Zimmer-Biomet) in addition to standard government funded physiotherapy. Results: Overall result for pre-operative TFA was 4.2 ± 0.6 out of 5. When comparing TFA results for patients who filled both pre-operative and post-operative TFAs, there was a statistically significant decrease in post-operative TFAs. Subgroup analysis revealed higher levels of self-efficacy in pre-operative TFAs with university level education compared to non-university, and lower levels of acceptability in post-operative TFAs with TKA compared to THA. USE questionnaire revealed a good level of satisfaction with usage of the app and PROMs showed improvement in THA but not in TKA at average 31.2 days follow-up. Conclusions: There was a good level of acceptability with the use of mymobility® for the post-operative management in THA and TKA, although acceptability decreased post-operatively. Higher education was associated with higher acceptability, whereas TKA as the procedure was associated with lower acceptability. Reduction in acceptability post-operatively could signify high expectations towards the app pre-operatively, higher than expected difficulties and pain in the early post-operative period, or the need for app improvement.

Perspectives of Frontline Clinicians and End-Line Users on Smartphone-Based Photography for Assessing Traumatic Dental Injuries: Focus Group Interview Study and Thematic Analysis

2026-01-26T17:00:04-05:00

Background: Mobile health (mHealth) is increasingly used in teledentistry for telediagnosis and other services; yet, the perceptions of frontline clinicians and end-line users regarding these technologies remain unexplored. Objective: This study examined the acceptability, feasibility, and usability of an mHealth model for telediagnosis from the perspectives of frontline clinicians and end-line users. Methods: A qualitative study using focus group interviews was conducted with 15 participants, including frontline clinicians and end-line users. Frontline clinicians captured dental images via a smartphone app, while end-line users assessed them through an mHealth platform. Interview transcriptions were thematically analyzed using consensus coding. Results: Thematic analysis identified 9 key themes: feasibility and perceived ease of use, perceived usefulness, compatibility, self-image and social influences, self-efficacy, voluntariness and behavior intention, anxiety, facilitating conditions, and attitudes toward a behavior. Participants considered smartphone-based photography acceptable and feasible for remote dental assessment. Facilitators and barriers to implementing the mHealth model were highlighted, and recommendations for improvements were proposed. Conclusions: Cyclical education and professional development are essential to enhancing user confidence and technology usability. Addressing patient and clinician resistance through targeted education, improved communication, and operational upgrades such as camera grids, system integration, and simplified login can support adoption. This study highlights mHealth’s potential in emergency dental assessment and screening, particularly for underserved populations, and underscores opportunities for interprofessional collaboration. Future research should explore broader clinical applications across oral health conditions. Trial Registration: