BACKGROUND: Harnessing mobile health (mHealth) solutions could improve the delivery of mental health services and mitigate their impact in Uganda and similar low-resource settings. However, successful adoption requires that mHealth solutions have good usability. We have previously implemented a telephone service to provide mental health information and advice in English and Luganda, utilizing an automated interactive voice response (IVR) system linked to live agents, including mental health care workers and peer support workers. OBJECTIVE: This study aims to assess the usage and usability of this mental health telephone service. METHODS: We obtained usage data from the system’s call logs over 18 months to study call volumes and trends. We then surveyed callers to gather their characteristics and assess usability using the Telehealth Usability Questionnaire. Additionally, call recordings were evaluated for conversation quality by 3 independent health care professionals, using the Telephone Nursing Dialogue Process, and correlations between quality and usability aspects were investigated. RESULTS: Over 18 months, the system received 2863 meaningful calls (ie, calls that went past the welcome message) from 1125 unique telephone numbers. Of these, 1153 calls (40.27%) stopped at the prerecorded IVR information, while 1710 calls (59.73%) opted to speak to an agent. Among those who chose to speak with an agent, 1292 calls (75.56%) were answered, 393 calls (22.98%) went to voicemail and were returned in the following working days, and 25 calls (1.46%) were not answered. Usage was generally sustained over time, with spikes in call volume corresponding to marketing events. The survey (n=240) revealed that most callers were caregivers of patients with mental health issues (n=144, 60.0%) or members of the general public (n=46, 19.2%), while a few were patients with mental health issues (n=44, 18.3%). Additionally, the majority were male (n=143, 59.6%), spoke English (n=180, 75.0%), had postsecondary education (n=164, 68.3%), lived within 1 hour or less from Butabika Hospital (n=187, 77.9%), and were aged 25-44 years (n=160, 66.7%). The overall usability score for the system was 4.12 on a 5-point scale, significantly higher than the recommended target usability score of 4 (P=.006). The mean scores for usability components ranged from 3.66 for reliability to 4.41 for ease of use, with all components, except reliability, scoring higher than 4 or falling within its CI. Usability scores were higher for Luganda speakers compared with English speakers, but there was no association with other participant characteristics such as sex, distance from the hospital, age, marital status, duration of symptoms, or treatment status. The quality of call conversations (n=50) was rated at 4.35 out of 5 and showed a significant correlation with usability (Pearson r=0.34, P=.02). CONCLUSIONS: We found sustained usage of the mental health telephone service, along with a positive user experience and high satisfaction across various user characteristics. mHealth solutions like this should be embraced and replicated to enhance the delivery of health services in Uganda and similar low-resource settings. 

BACKGROUND: Mental health conditions are a significant public health problem globally, responsible for >8 million deaths per year. In addition, they lead to lost productivity, exacerbate physical illness, and are associated with stigma and human rights violations. Uganda, like many low- and middle-income countries, faces a massive treatment gap for mental health conditions, and numerous sociocultural challenges exacerbate the burden of mental health conditions. OBJECTIVE: This study aims to describe the development and formative evaluation of a digital health intervention for improving access to mental health care in Uganda. METHODS: This qualitative study used user-centered design and design science research principles. Stakeholders, including patients, caregivers, mental health care providers, and implementation experts (N=65), participated in focus group discussions in which we explored participants' experience of mental illness and mental health care, experience with digital interventions, and opinions about a proposed digital mental health service. Data were analyzed using the Consolidated Framework for Implementation Research to derive requirements for the digital solution, which was iteratively cocreated with users and piloted. RESULTS: Several challenges were identified, including a severe shortage of mental health facilities, unmet mental health information needs, heavy burden of caregiving, financial challenges, stigma, and negative beliefs related to mental health. Participants' enthusiasm about digital solutions as a feasible, acceptable, and convenient method for accessing mental health services was also revealed, along with recommendations to make the service user-friendly, affordable, and available 24×7 and to ensure anonymity. A hospital call center service was developed to provide mental health information and advice in 2 languages through interactive voice response and live calls with health care professionals and peer support workers (recovering patients). In the 4 months after launch, 456 calls, from 236 unique numbers, were made to the system, of which 99 (21.7%) calls went to voicemails (out-of-office hours). Of the remaining 357 calls, 80 (22.4%) calls stopped at the interactive voice response, 231 (64.7%) calls were answered by call agents, and 22 (6.2%) calls were not answered. User feedback was positive, with callers appreciating the inclusion of peer support workers who share their recovery journeys. However, some participant recommendations (eg, adding video call options) or individualized needs (eg, prescriptions) could not be accommodated due to resource limitations or technical feasibility. CONCLUSIONS: This study demonstrates a systematic and theory-driven approach to developing contextually appropriate digital solutions for improving mental health care in Uganda and similar contexts. The positive reception of the implemented service underscores its potential impact. Future research should address the identified limitations and evaluate clinical outcomes of long-term adoption.

This paper takes a system approach to implementation of future health and welfare technology aiming at prolonging independent life. A study was conducted where different relevant stakeholders such as older adults, care staff, managers, and decision makers were interviewed about their visions and attitudes towards the use of technology in a future context. Further, the paper elaborates on how information design can contribute to the understanding of different needs and how it can be applied in the development of health and welfare technology that empowers future older adults and contribute to a prolonged independent life. Finally, communication and interaction design are discussed in relationship to the usage of future health and welfare technology.

Thanks to its non-invasive nature and high-resolution imaging capabilities, magnetic resonance imaging (MRI) is a valuable diagnostic tool for pediatric patients. However, the fear and anxiety experienced by young children during MRI scans often result in suboptimal image quality and the need for sedation/anesthesia. This study aimed to evaluate the effect of a smartphone application called COSMO@home to prepare children for MRI scans to reduce the need for sedation or general anesthesia. The COSMO@home app was developed incorporating mini-games and an engaging storyline to prepare children for learning goals related to the MRI procedure. A multicenter study was conducted involving four hospitals in Belgium. Eligible children aged 4–10 years were prepared with the COSMO@home app at home. Baseline, pre-scan, and post-scan questionnaires measured anxiety evolution in two age groups (4–6 years and 7–10 years). Eighty-two children participated in the study, with 95% obtaining high-quality MRI images. The app was well-received by children and parents, with minimal technical difficulties reported. In the 4–6-year-old group (N = 33), there was a significant difference between baseline and pre-scan parent-reported anxiety scores, indicating an increase in anxiety levels prior to the scan. In the 7–10-year-old group (N = 49), no significant differences were observed between baseline and pre-scan parent-reported anxiety scores. Overall, the COSMO@home app proved to be useful in preparing children for MRI scans, with high satisfaction rates and successful image outcomes across different hospitals. The app, combined with minimal face-to-face guidance on the day of the scan, showed the potential to replace or assist traditional face-to-face training methods. This innovative approach has the potential to reduce the need for sedation or general anesthesia during pediatric MRI scans and its associated risks and improve patient experience.

Stereotypes regarding ageing and the use of technology have an impact on how older adults perceive themselves as users of technology. Purchasing groceries online and using tablets for communication are two digital services that have been implemented in a number of municipalities in Sweden. For both these services, choices have been made with respect to how to implement the solutions and how older adults should be introduced to the technology. This work is based on interviews with personnel within one of the municipalities. The participants were asked about the introduction and implementation of the technology, about their expectations, and about how they and the older adults perceived the introduction and the usage. The interviews revealed no strong negative attitudes towards older adults as technology users. Among the personnel engaged coworkers could be found, but the importance of having enough time to engage the older adults was also highlighted. © 2021, The Author(s)

The overall aim with the paper is to create a starting point for a design framework that incorporates elements that support the participants’, in this case older adults, feeling of social belonging, being knowledgeable and able to contribute. The paper describes different aspects of ageism and stereotypes related to older adults and the design and use of digital technology. The paper also places these stereotypes in relationship to self-efficacy and how degrading and internalized stereotypes affect motivation to learn and use new technology. Further, the paper presents examples from conducted projects where co-operation and co-creation have reduced the impact of negative stereotypes in the design process; and highlights design guidelines aiming at reducing the impact of negative stereotypes. Finally, the paper elaborates on elements that could be included in the design process to enhance self-efficacy alongside with developing meaningful digital tools that are motivating to use.

Welfare technology (WT) is often developed with a technical perspective, and little consideration is taken regarding the involvement of important ethical considerations and different values that come up during the development and implementation of WT. Safety, security and privacy are significant, as well as the usability and overall benefit of the tool, but to date assessments often lack a holistic picture of the WT as seen by the users. This paper suggests a user-centered ethical assessment (UCEA) framework for WT to be able to evaluate ethical consequences as a part of the user-centered aspects. Building on established methodologies from research on ethical considerations, as well as the research domain of human-computer interaction, this assessment framework joins knowledge of ethical consequences with aspects affecting the “digitalization with the individual in the center”, e.g. privacy, safety, well-being, dignity, empowerment and usability. The framework was applied during development of an interface for providing symptom information to Parkinson patients. The results showed that the UCEA framework directs the attention to values emphasized by the patients. Thus, functionality of the system was evaluated in the light of values and expected results of the patients, thereby facilitating follow-up of a user-centered assessment. The framework may be further developed and tested, but in this study it served as a working tool for assessing ethical consequences of WT as a part of user-centered aspects.

Serious games are an established field of study, where exergames provide a combination of conducting exercises and playing games. The aim of this work was to identify important features to include in, and design recommendations for exergames using sensor technology. The outcome of this work was two-folded. Firstly, a literature review of design guidelines with respect to older adults as users of exergames resulted in a categorized summary of design guidelines for specific target groups, e.g. people undergoing physical rehabilitation after stroke or injury or users suffering from a chronic disease. Secondly, these guidelines are discussed from various perspectives, based on insights from several years of work in the area. A general design guidelines covered by most of the literature is that exergames should provide a wide range of difficulty levels and be possible to adjust to individual needs. Insights from own work in the area highlight the importance of task and context relevant tools and devices. The result will serve as a starting point for a framework consisting of both general and domain specific design guidelines when designing sensor-based exergames for older adults.

In this paper we discuss how theories of vision, touch, sound, and learning behavior can form a basis for the development of a testbed through which real-life task performance can be compared with task performance in a Virtual Reality (VR) environment. By taking a multisensory approach, it will be possible to simulate the functionalities of a real training setting in a VR environment. Approaching this problem from a theoretical perspective, we will view it from a new angle and discuss whether we can enhance and nuance feedback in the virtual experience through the use of ambient media like sound, scent, heat, and wind. Sound may hold a great potential here. For visual perception, it is not only crucial that we can see relationships but that we are also able to search for patterns that we recognize. If an object is taken outside its context, its meaning can easily shift. To see is to search for patterns, but vision is also dependent on our experience of other senses. We can imagine how a given surface might feel by looking at a representation of the object, and this is because of previous tactile experiences with similar objects. From a technical perspective, integrating sound in a virtual environment is a straightforward process. Research shows that the process of learning a series of physical actions can be enhanced when it occurs in parallel with verbal or written information. In the literature, this phenomenon is described in terms of enactment or subject-performed tasks. Based on theories regarding vision, touch, sound and learning behavior, we suggest the design of a testbed that can be used in a pilot study aimed at increasing knowledge on how VR and AR can support learning in an assembly or installation context in order to produce guidelines for such an environment.