Eye-tracking is deemed a promising methodology for usability evaluation studies in healthcare, however clear theoretical guidance and practice remains lacking. A rapid review was performed on current use of eye tracking as a usability evaluation method on digital health technologies in the period of 2019 to 2024. Usability evaluation studies were included when they described a digital health technology intervention in which eye-tracking technologies were applied. To gain insight into how eye-tracking technologies contributed to measuring digital health technologies\' usability, data was extracted on the use of eye-tracking for usability and key study findings. Seventeen papers were included in the review. Findings show that eye-tracking is frequently combined with other usability evaluation methods, with high methodological diversity, to test the usability of DHT. Future research is needed to enhance understanding of the effectiveness of eye-tracking outcomes in DHT usability testing when combined with other usability evaluation methods in order to provide (usability) researchers theoretical guidance on its application.

Seldom-heard groups refer to individuals whose voices are often marginalised, underrepresented, or not adequately considered in the digital design process. This case study aims to demonstrate the benefits of taking a user-centred design (UCD) approach to implementing a digital solution for Maternity Services in Wales. Semi-structured interviews were conducted to understand the needs of women and birthing people from seldom-heard groups. The research insights were used to inform the design of a service pattern that could be delivered before and after each maternity appointment. The research shows opportunities to improve the experience for women and birthing people and reduce their anxieties by creating a reliable, accessible digital maternity record that will empower them to make evidence-based decisions. By taking a user-centred design approach and centering the unique needs of those facing the greatest health disparities, Maternity Services\' digital transformation aims to positively impact the health and well-being of women and birthing people in Wales.

The full potential for electronic health record systems in facilitating a positive transformation in care, with improvements in quality and safety, has yet to be realised. There remains a need to reconceptualise the structure, content and use of the nursing component of electronic health record systems. The aim of this study was to engage and involve a diverse group of stakeholders, including nurses and electronic health record system developers, in exploring together both issues and possible new approaches to documentation that better fit with practice, and that facilitate the optimal use of recorded data. Three focus groups were held in the UK and USA, using a semi-structured interview guide, and a common reflexive approach to analysis. The findings were synthesised into themes that were further developed into a set of development principles that might be used to inform a novel electronic health record system specification to support nursing practice.

BACKGROUND: Adverse events (AEs) are commonly reported in clinical studies using the Medical Dictionary for Regulatory Activities (MedDRA), an international standard for drug safety monitoring. However, the technical language of MedDRA makes it challenging for patients and clinicians to share understanding and therefore to make shared decisions about medical interventions. In this project, people with lived experience of depression and antidepressant treatment worked with clinicians and researchers to co-design an online dictionary of AEs associated with antidepressants, taking into account its ease of use and applicability to real-world settings.
METHODS: Through a pre-defined literature search, we identified MedDRA-coded AEs from randomised controlled trials of antidepressants used in the treatment of depression. In collaboration with the McPin Foundation, four co-design workshops with a lived experience advisory panel (LEAP) and one independent focus group (FG) were conducted to produce user-friendly translations of AE terms. Guiding principles for translation were co-designed with McPin/LEAP members and defined before the finalisation of Clinical Codes (CCs, or non-technical terms to represent specific AE concepts). FG results were thematically analysed using the Framework Method.
RESULTS: Starting from 522 trials identified by the search, 736 MedDRA-coded AE terms were translated into 187 CCs, which balanced key factors identified as important to the LEAP and FG (namely, breadth, specificity, generalisability, patient-understandability and acceptability). Work with the LEAP showed that a user-friendly language of AEs should aim to mitigate stigma, acknowledge the multiple levels of comprehension in \'lay\' language and balance the need for semantic accuracy with user-friendliness. Guided by these principles, an online dictionary of AEs was co-designed and made freely available ( https://thesymptomglossary.com ). The digital tool was perceived by the LEAP and FG as a resource which could feasibly improve antidepressant treatment by facilitating the accurate, meaningful expression of preferences about potential harms through a shared decision-making process.
CONCLUSIONS: This dictionary was developed in English around AEs from antidepressants in depression but it can be adapted to different languages and cultural contexts, and can also become a model for other interventions and disorders (i.e., antipsychotics in schizophrenia). Co-designed digital resources may improve the patient experience by helping to deliver personalised information on potential benefits and harms in an evidence-based, preference-sensitive way.

BACKGROUND: Pharmacogenetics can impact patient care and outcomes through personalizing the selection of medicines, resulting in improved efficacy and a reduction in harmful side effects. Despite the existence of compelling clinical evidence and international guidelines highlighting the benefits of pharmacogenetics in clinical practice, implementation within the National Health Service in the United Kingdom is limited. An important barrier to overcome is the development of IT solutions that support the integration of pharmacogenetic data into health care systems. This necessitates a better understanding of the role of electronic health records (EHRs) and the design of clinical decision support systems that are acceptable to clinicians, particularly those in primary care.
OBJECTIVE: Explore the needs and requirements of a pharmacogenetic service from the perspective of primary care clinicians with a view to co-design a prototype solution.
METHODS: We used ethnographic and think-aloud observations, user research workshops, and prototyping. The participants for this study included general practitioners and pharmacists. In total, we undertook 5 sessions of ethnographic observation to understand current practices and workflows. This was followed by 3 user research workshops, each with its own topic guide starting with personas and early ideation, through to exploring the potential of clinical decision support systems and prototype design. We subsequently analyzed workshop data using affinity diagramming and refined the key requirements for the solution collaboratively as a multidisciplinary project team.
RESULTS: User research results identified that pharmacogenetic data must be incorporated within existing EHRs rather than through a stand-alone portal. The information presented through clinical decision support systems must be clear, accessible, and user-friendly as the service will be used by a range of end users. Critically, the information should be displayed within the prescribing workflow, rather than discrete results stored statically in the EHR. Finally, the prescribing recommendations should be authoritative to provide confidence in the validity of the results. Based on these findings we co-designed an interactive prototype, demonstrating pharmacogenetic clinical decision support integrated within the prescribing workflow of an EHR.
CONCLUSIONS: This study marks a significant step forward in the design of systems that support pharmacogenetic-guided prescribing in primary care settings. Clinical decision support systems have the potential to enhance the personalization of medicines, provided they are effectively implemented within EHRs and present pharmacogenetic data in a user-friendly, actionable, and standardized format. Achieving this requires the development of a decoupled, standards-based architecture that allows for the separation of data from application, facilitating integration across various EHRs through the use of application programming interfaces (APIs). More globally, this study demonstrates the role of health informatics and user-centered design in realizing the potential of personalized medicine at scale and ensuring that the benefits of genomic innovation reach patients and populations effectively.

Parenting practices have a profound effect on children\'s well-being and are a core target of several psychological interventions for child mental health. However, there is only limited understanding in HCI so far about how to design socio-technical systems that could support positive shifts in parent-child social practices in situ. This paper focuses on parental socialisation of emotion as an exemplar context in which to explore this question. We present a two-step study, combining theory-driven identification of plausible design directions with co-design workshops with 22 parents of children aged 6-10 years. Our data suggest the potential for technology-enabled systems that aim to facilitate positive changes in parent-child social practices in situ, and highlight a number of plausible design directions to explore in future work.

This report summarises the SMARTCLAP research project, which employs a user-centred design approach to develop a revolutionary smart product service system. The system offers personalised motivation to encourage children with cerebral palsy to actively participate more during their occupational therapy sessions, while providing paediatric occupational therapists with an optimal tool to monitor children\'s progress from one session to another. The product service system developed includes of a smart wearable device called DigiClap used to interact with a serious game in an Augmented Reality environment. The report highlights the research methodology used to advance the technology readiness level from 4 to 6, acknowledging the contribution of the consortium team and funding source. As part of the technology\'s maturity process, DigiClap and the respective serious game were evaluated with target users, to identify the system\'s impact in supporting the children\'s overall participation and hand function, and to gather feedback from occupational therapists and caregivers on this novel technology. The outcomes of this study are discussed, highlighting limitations and lessons learned. The report also outlines future work and further funding for the sustainability of the project and to reach other individuals who have upper limb limitations. Ultimately, the potential of DigiClap and the overall achievements of this project are discussed.

BACKGROUND: The threat of antimicrobial resistance is triggering the need for behavioural change towards antimicrobial use on Irish farms. Newly introduced veterinary medicine regulations are mandating the restricted and more prudent use of antimicrobials in the animal health sector. The need to reduce antimicrobials has placed a greater emphasis on the importance of animal health testing, however, issues with current testing practices are affecting diagnosis and subsequent drug usage. There is potential for digital technologies to address these issues and reduce antimicrobial use on farms, however, for these tools to be successful, they would need to be developed in collaboration with future end users.
RESULTS: Using qualitative approaches (focus groups), this study engages with dairy farmers and farm veterinary practitioners to detail current challenges with animal health diagnosis and to explore the initial development of a rapid, on-farm animal health testing tool to address these challenges. Issues with timing and testing, the role of knowledge and experience, and veterinarian availability all affect the ability of farmers and veterinarians to diagnose animal health issues on farm. These issues are having negative implications including the increased and unnecessary use of antimicrobials. An on-farm testing tool would help mitigate these effects by allowing veterinarians to achieve rapid diagnosis, facilitating the timely and targeted treatment of animal illnesses, helping to reduce overall antimicrobial use on farms. However, engagement with end users has highlighted that if a tool like this is not developed correctly, it could have unintended negative consequences such as misdiagnosis, increased antimicrobial use, challenges to farmer-veterinarian relationships, and data misuse. This study outlines initial end user needs and requirements for a testing tool but suggests that in order to successfully design and develop this tool, co-design approaches such as Design Thinking should be applied; to mitigate future negative impacts, and to ensure a testing tool like this is designed specifically to address Irish dairy farmers and farm veterinarians\' values and needs, ensuring responsible and successful uptake and use.
CONCLUSIONS: Digital tools can be effective in reducing antimicrobial use on farms, however, to be successful, these tools should be designed in a user centred way.

Oropharyngeal dysphagia, or difficulty initiating swallowing, is a frequent problem in people with Parkinson\'s disease (PD) and can lead to aspiration pneumonia. The efficacy of pharmacological options is limited. Postural strategies, such as a chin-down manoeuvre when drinking, have had some degree of success but may be difficult for people who have other limitations such as dementia or neck rigidity, to reproduce consistently. Using a user-centred design approach and a multidisciplinary team, we developed and tested an anti-choking mug for people with PD that helps angle the head in the optimum position for drinking. The design reflected anthropometric and ergonomic aspects of user needs with features including regulation of water flow rate and sip volume, an inner slope, a thickened handle and a wide base, which promoted a chin-down posture when used. Prototype testing using digital technology to compare neck flexion angles (the primary outcome), plus clinical outcomes assessed using standard tools (Swallowing Clinical Assessment Score in Parkinson\'s Disease (SCAS-PD) and Movement Disorder Society-Unified Parkinson\'s Disease Rating Scale (MDS-UPDRS) Parts II and III), found significant improvements in a range of parameters related to efficient swallowing and safe drinking when using the anti-choking mug versus a sham mug.

OBJECTIVE: To evaluate and improve \"Making Alternative Treatment Choices Intuitive and Trustworthy\" (MATCH-IT)-a digital, interactive decision support tool displaying structured evidence summaries for multiple comparisons-to help physicians interpret and apply evidence from network meta-analysis (NMA) for their clinical decision-making.
METHODS: We conducted a qualitative user testing study, applying principles from user-centered design in an iterative development process. We recruited a convenience sample of practicing physicians in Norway, Belgium, and Canada, and asked them to interpret structured evidence summaries for multiple comparisons-linked to clinical guideline recommendations-displayed in MATCH-IT. User testing included (a) introduction of a clinical scenario, (b) a think-aloud session with participant-tool interaction, and (c) a semistructured interview. We video recorded, transcribed, and analyzed user tests using directed content analysis. The results informed new updates in MATCH-IT.
RESULTS: Distributed across 5 development cycles we tested MATCH-IT with 26 physicians. Of these, 24 (94%) reported either no or sparse prior experience with interpretation of NMA. Physicians perceived MATCH-IT as easy to interpret and navigate, and appreciated its ability to provide an overview of the evidence. Visualization of effects in pictograms and inclusion of information on burden of treatment (\"practical issues\") were highlighted as potentially useful features in interacting with patients. We also identified problems, including undiscovered functionalities (drag and drop), suboptimal tutorial, and cumbersome navigation of the tool. In addition, physicians wanted definition/explanation of key terms (eg, outcomes and \"certainty\"), and there were concerns that overwhelming evidence from a large NMA would complicate applicability to clinical practice. This led to several updates with development of a new start page, tutorial, updated user interface for more efficient maneuvering, solutions to display definition of key terms and a \"frequently asked questions\" section. To facilitate interpretation of large networks, we improved categorization of results using color coding and added filtering functionality. These modifications allowed physicians to focus on interventions of interest and reduce information overload.
CONCLUSIONS: This study provides proof of concept that physicians can use MATCH-IT to understand NMA evidence. Key features of MATCH-IT in a clinical context include providing an overview of the evidence, visualization of effects, and the display of information on burden of treatments. However, unfamiliarity with the Grading of Recommendations Assessment, Development and Evaluation concepts, time constraints, and accessibility at the point of care may be challenges for use. To what extent our results are transferable to real-world clinical contexts remains to be explored.