背景:疲劳是许多患者的重要症状,包括肾病患者.认知偏见,比如注意偏见和自我认同偏见,被认为会影响疲劳。认知偏差修正(CBM)训练是一种有前途的对抗疲劳的技术。
目的:我们旨在评估肾脏病患者和医疗保健专业人员(HCP)的CBM培训,并使用迭代设计过程评估临床环境中的可接受性和适用性,以评估培训的期望和经验。
方法:这是纵向的,定性,以及多个利益相关者视角的可用性研究,我们在原型设计阶段和培训结束后采访了最终用户和HCP。我们对29名患者和16名HCP进行了半结构化访谈。访谈是按主题进行转录和分析的。接下来是对培训的总体评估,使用可接受性理论框架评估培训的可接受性,通过评估在肾脏护理环境中实施的障碍和解决方案来评估适用性。
结果:一般来说,参与者对培训及其适用性持积极态度。最大的负面影响是对有效性的怀疑和对CBM重复性的烦恼。通过混合评估来判断可接受性,对感知有效性的负面评价;负担的混合结果,干预一致性,和自我效能感;情感态度的积极结果,伦理,和机会成本。适用性的障碍是患者不同的计算机技能,疲劳的主观性,并与常规治疗相结合(例如,HCP的作用)。可能的解决方案包括在护士中分配代表,在应用程序上提供培训,并通过服务台提供帮助。迭代设计过程,包括反复测试用户期望和体验,产生了补充数据。
结论:据我们所知,本研究首次引入CBM训练靶向性疲劳。此外,这项研究提供了对CBM培训的首批用户评估之一,在肾脏疾病患者和他们的护理提供者中。总的来说,培训得到了积极评价,虽然可接受性显示结果好坏参半。尽管发现了障碍,但适用性是积极的。建议的解决方案需要进一步测试,最好遵循相同的框架,因为这项研究的迭代对培训质量有积极的贡献。因此,未来的研究应遵循相同的框架,并在电子健康干预设计中考虑利益相关者和最终用户。
BACKGROUND: Fatigue is an important symptom for many patients, including patients with kidney disease. Cognitive biases, such as attentional bias and self-identity bias, are thought to influence fatigue. Cognitive bias modification (CBM) training is a promising technique to counter fatigue.
OBJECTIVE: We aimed to evaluate a CBM training among patients with kidney disease and health care professionals (HCPs) and assess acceptability and applicability in the clinical setting using an iterative design process to evaluate expectations and experiences with the training.
METHODS: This was a longitudinal, qualitative, and multiple stakeholder-perspective usability
study in which we interviewed end users and HCPs during the prototyping phase and after the end of training. We conducted semistructured interviews with 29 patients and 16 HCPs. The interviews were transcribed and analyzed thematically. Next to a general evaluation of the training, the acceptability of the training was evaluated using the Theoretical Framework of Acceptability, and applicability was assessed by evaluating obstacles and solutions for implementation in the kidney care setting.
RESULTS: Generally, participants were positive about the training and its applicability. The biggest negatives were doubts about effectiveness and annoyance about the repetitive character of CBM. Acceptability was judged with a mixed evaluation, with a negative evaluation of perceived effectiveness; mixed results for burden, intervention coherence, and self-efficacy; and positive results for affective attitude, ethicality, and opportunity costs. Barriers for applicability were patients\' varying computer skills, subjectivity of fatigue, and integration with regular treatment (eg, the role of HCPs). Possible solutions included assigning representatives among nurses, offering training on an app, and providing assistance via a help desk. The iterative design process, including repeated waves of testing user expectations and experiences, yielded complementary data.
CONCLUSIONS: To the best of our knowledge, this
study is the first to introduce a CBM training targeting fatigue. Furthermore, this
study provides one of the first user evaluations of a CBM training, both among patients with kidney disease and their care providers. Overall, the training was evaluated positively, although acceptability showed mixed results.
Applicability was positive although barriers were identified. The proposed solutions require further testing, preferably following the same frameworks, as the iteration in this
study contributed positively to the quality of the training. Therefore, future research should follow the same frameworks and consider stakeholders and end users in eHealth intervention design.