Eye tracking is recognized as a gold standard for measuring visual attention and cognitive engagement. In this study, it offers a useful lens for understanding how primary care providers balance patient communication with navigation of electronic health records (EHRs). We used wearable eye tracking to collect visual information processing behavior and conducted a retrospective think-aloud protocol to examine how primary care clinicians processed suicide-related information (CAT-MH®) embedded in the EHR during simulated visits. Eye-movement data showed substantial visual attention directed toward the EHR, indicating added information-processing demands during communication. Retrospective think-aloud data supported the analysis of eye movement data by revealing that clinicians searched multiple record sections to verify risk indicators and often postponed suicide-related discussions until confirming relevant results. These findings illustrate how EHR-embedded screening tools shape clinical attention and encounter flow.

In this paper, we focus on objectively measuring cognitive engagement using eye-tracking techniques. Specifically, we analyze both gaze-based and pupil-based eye movement data to assess attention and absorption-two key dimensions of cognitive engagement. These ocular behaviors serve as complementary indicators of cognition, providing a more comprehensive representation of cognitive engagement. Using these objective measures, we examine how navigation style influences cognitive engagement with an 18-page web-based medical decision aid (DA). Our findings demonstrate that evaluating cognitive engagement through the objective measures of attention and absorption offers a more holistic understanding of user engagement. Furthermore, because the system used in our study supports emotionally taxing decision-making, our results extend the measurement of cognitive engagement to contexts beyond those driven by affective states such as flow.

There is a lack of consensus regarding the impact of elevated indoor CO2 exposure on cognition. COVID-19 provided an opportunity to study responses to long-term elevated CO2 exposure from facemask wear. Such an opportunity allows us to avoid exposing participants to elevated CO2 levels not typically experienced in real-life settings, potentially increasing the ecological validity of our experimental design. Further, the worsening warmness during summer necessitates studies and understanding of peoples’ cognition with combined stressors of both heat and CO2 accumulation. In this work, we recruited 60 college students to understand whether facemask wear elevates local CO2 levels and, if so, the extent to which it impacts cognition in warm conditions. Subjects remained in a controlled summer environmental room (temperature 31.5°C, relative humidity 30%) for 90 min with or without facemasks. Participants completed six cognitive tests in a random order and answered surveys using computer-based software. Ten experimental subjects had a second 30 min visit to measure CO2 concentration at the ala of the nose with and without surgical masks. The results show that wearing a surgical mask sharply increased CO2 concentration near the nose by 15,000 ppm. Our analysis showed that the experimental group with facemask wear did not exhibit significantly different cognition performance except for short-term memory which was higher instead of lower than the control group. Participants with facemask wear showed significantly lower risk-taking, possibly attributed to thermal discomfort. Nevertheless, no significance in cognition or decision-making was observed after controlling the familywise error rate using the Bonferroni correction. We hypothesize that the insignificant difference might be caused by adaptation to long-term wear and high CO2 exposure in daily life during COVID-19, which cannot be revealed in the studies prior to the pandemic.

The pressing need for objective measures in evaluating chronic pain in research and practice highlights the role that neuro information systems (NeuroIS) research plays in designing smart clinical decision support systems. A first step in such a research agenda involves identifying practical stimuli-task paradigms that can reliably detect chronic pain from physiological measures such as eye movements. In this study, we propose and test a new stimuli-task paradigm. Our results show that our proposed stimuli-task paradigm can detect differences in the information-processing behavior of people with and without chronic pain. The results also show that our proposed stimuli-task paradigm can reliably predict self-reported subjective pain experience from eye movements. These findings provide support for our proposed stimuli-task paradigm. They also show that the eye-tracking variables that we selected to test our proposed paradigm are effective in capturing the impact of chronic pain on visual attention, suggesting that eye movements have the potential to serve as reliable biomarkers of chronic pain. Hence, our results support the potential for eye movements to aid in efforts to develop smart information systems that can detect the presence and/or the severity of chronic pain from an individual's ocular behavior.

Smart clinician support systems using biomarkers such as patients' eye movements can significantly enhance the assessment of chronic pain which traditionally relies on subjective self-reports. This exploratory study expands research on eye-movement data as a potential biomarker for chronic pain assessment by investigating two relevant eye-movement metrics that have not been considered by the chronic pain literature: Fixation Inner Density (FID) and baseline-corrected Pupil Diameter (PD). Data was collected from participants with and without chronic pain as they answered pain-related surveys. Our results suggest that FID and PD can provide objective insights into attentional biases related to chronic pain, offering promising avenues for developing smart Clinician Decision Support Systems (CDSS) that use biomarkers to enhance pain assessment and management. Future research will focus on validating these preliminary results with larger sample sizes and exploring the scalability of these metrics for clinical applications.

The User Experience-driven Innovation (UXDI) framework emphasizes that successful product design, irrespective of organizational or personal systems, considers the user, context, and technology. In this paper, we outline a generative UX research process to study user needs for teleoperation robotics systems that can assist employees in specialized tasks under stressful conditions as there has been minimal work in documenting such processes. Grounded in the sociotechnical systems (STS) theory we developed a tasks-first approach to studying employee needs for professional service robots. We designed worksheets for 1) identifying project tasks and their Key Performance Indicators (KPIs), 2) creating high-level and detailed task experience maps, and 3) developing personas for employees who complete the identified tasks. The experience maps and personas can then be used to generate insights for designing robotic systems that can assist employees with the identified tasks.

In the neurological intensive care unit (neuroICU), patients with severe acute brain injury (SABI) are rendered unable to make their own healthcare decisions. The responsibility of making life-or-death decisions, such as goals of care, is carried by surrogate decision-makers, usually families. In addition to the burden of decision-making, the emotional burden on families is further compounded by prognostication uncertainty, time-pressure for decision-making, and difficulties in understanding and interpreting the patient's values and preferences, ultimately resulting in potential clinician-family communication breakdown. Despite these challenges, there is currently no guidance on how to best approach these difficult decisions. Shared decision-making (SDM) has emerged as the recommended approach to improve clinician-family communication, empowering surrogates to take an active role in decision-making by providing a structured framework for information exchange, deliberation, and treatment decisions. Decision aids (DAs) facilitate SDM by offering balanced, accessible, unbiased information and helping surrogates decide according to patients' values. This review highlights the potential advantage of digital over paper-based DAs, including improved accessibility, interactivity, and personalization, and the integration of emerging technologies to enhance DA effectiveness. Additionally, we review the current digital DAs developed for the neuroICU setting.

The objective of this study is to investigate the effectiveness of a local wearable cooling solution in improving thermal comfort, emotional state, and cognitive performance. The study was conducted in an environmental room with air temperature of 31.5 +/- 0.26 degrees C. Thirty participants performed six cognitive tasks while periodically assessing their thermal experience locally where the cooling (Embr wave) was applied and for the whole body, as well as emotional states. The same protocol was applied to another thirty participants as the control group without local cooling. We also measured mean skin temperature and local skin temperature beneath the cooling device during the whole session. The results showed a significant drop in thermal sensation right after the application of the local cooling. Based on the ASHRAE 7 -point scale for the overall thermal sensation vote, the local sensation dropped from 0.8 to -0.4 and the whole-body thermal sensation from 1.34 to 0.87. Over the 60 min of local cooling application, the local thermal sensation dropped from 0.98 to 0.04 and the whole-body thermal sensation dropped from 1.37 to 1.12. Furthermore, the local cooling group showed a significant drop in negative emotions and an increase in positive emotions compared to the control group. For cognitive performance, local cooling groups showed to be more inclined for risk taking for more rewards compared to the control group. The performance of other cognitive tests showed no significant difference between the two groups, even though attention, working memory and creativity were enhanced slightly but insignificantly.

In user experience (UX) research, persona development can be particularly beneficial in designing digital health interventions. From our previous work, we identified challenges that diabetic patients face in adhering to guideline-recommended care through persona development. We developed data personas from Electronic Health Records (EHR) using two-step clustering and combined them with proto personas that were generated by a group of medical experts for the same patient population. Not only did our results prove beneficial for intervention design, but also highlighted fairness issues that may result from the underrepresentation of certain populations in EHR datasets. In our current paper, we validate the results of our prior work and we extend our previous work on persona development to build a model that can automatically associate a patient record to its representative data persona. The model was built using the results of the two-step clustering as the inputs. We believe that building such a model will help clinicians quickly trace new patient records to already developed personas, thereby assisting in immediate health interventions based on the health risk characteristics of the patient.

Research investigating the acceptance of information systems mostly focuses on systems designed for long-term use, rather than one-time or short-term use. However, short-term use systems are part of the health information technology portfolio. We propose a theoretical model inspired by the D&M IS Success Model to investigate user satisfaction, as a measure of acceptance, with a web-based decision aid designed for short-term decision-making. We hypothesize that media richness affects perceived usefulness, perceived ease of use, learnability, information quality, perceived social presence, and trust, which eventually affect user satisfaction. We propose a mixed method to test hypotheses using eye-tracking, surveys, and interviews. As a pilot qualitative study (N=8), the survey outcomes indicated that constructs performed well (mean 7-point Likert scores >= 5.15 and mean system usability scale = 75). The eye-tracking and interview results showed that participants prefer multimedia, and pictures and visual designs drew their attention to the decision aid website.

Eye tracking has become the gold standard in measuring human attention and information-processing behavior. As such, eye tracking in mixed-methods user experience (UX) research serves as an invaluable tool to learn about user needs and to create actionable insights for improving product and service design during the development cycle. Here, we discuss the iterative process that we used to improve the design of a decision aid (DA) developed to facilitate shared decision making. We explain the use of eye tracking during this process to examine how users processed the information provided by the DA. We also explain how we used eye tracking in a retrospective "think-aloud" protocol to gain insight about users' needs. Our results show that user reactions captured by eye tracking can not only be used to optimize design decisions but also to gather user feedback about their information processing needs.

Personas are fictional but realistic representations of user groups of a product or service that focus on their goals, needs, behavior, and other characteristics that may impact the design of the product. Using personas in the early phases of the design process can help identify product features, and demonstrate how these features address user needs and challenges. Despite being used in research for over a decade, there is a lack of standardized methodology on the development of personas and how they are used in the design process. The objective of this paper is to develop a systematic approach to the persona development process and show its effectiveness through a case study where we followed the proposed methodology in the early design phase of a diabetes management smartphone application (app) targeted at older and younger users. The study was conducted in United States from January to June 2020. The findings of our study provided an empirical examination of the effectiveness and efficiency of the design process using personas.

Anxiety, one of the most common mental illnesses among American adults, is often assessed via self-reported measures. While self-reported measures provide an efficient step in capturing health symptoms from patients’ point of view, by their mere nature self-reported measures provide only a narrow interpretation of health symptoms. Capturing eye movements unobtrusively during self-reports, when patients summarize their experience of anxiety by choosing a single option among a set of alternatives, can provide invaluable insight about patients’ information processing and decision behavior. Because anxiety impacts how we attended to information that we use to select options, the objective moment-to-moment eye-movement data can substantially enrich the information that is typically provided by patients as single scores representing their anxiety levels. Supporting this point of view, our results indicate that eye movements may serve as valuable objective information complementing the subjective self-reported anxiety measures to enable more effective assessment and treatment of anxiety.

BACKGROUND:Many individuals with suicide risk present to acute care settings such as emergency departments (EDs). However, staffing and time constraints mean that many EDs are not well equipped to deliver evidence-based interventions for patients experiencing suicidality. An existing intervention initiated in the ED for patients with suicide risk (Emergency Department Safety Assessment and Follow-up Evaluation [ED-SAFE]) has been found to be effective but faces trenchant barriers for widespread adoption.OBJECTIVE:On the basis of the ED-SAFE intervention, we aimed to develop 2 apps for patients with suicide risk: a web app guiding patients through safety planning in the ED (ED app) and a smartphone app providing patients components of the ED-SAFE program on their phones after discharge (patient app). We then tested the usability of these apps with patients presenting to the ED with suicide risk.METHODS:Using a user-centered design framework, we first developed user personas to explore the needs and characteristics of patients who are at risk for suicide using inputs from clinicians (n=3) and suicidologists (n=4). Next, we validated these personas during interviews with individuals with lived experience of suicidality (n=6) and used them to inform our application designs. We field-tested the apps with ED patients presenting with suicide risk (n=14) in 2 iterative cycles to assess their usability and engagement using a mixed methods approach. We also rated the quality and fidelity of the safety plans created.RESULTS:We developed 2 interoperable and complementary apps. The first is a web app designed for use on a tablet device during ED admission that guides the patient by creating a safety plan using a chatbot-style interface. The second is a smartphone app for use after discharge and allows the patient to view, edit, and share their completed safety plan; access self-care education, helplines, and behavioral health referrals; and track follow-up appointments with the study clinician. The initial prototype usability testing (n=9) demonstrated satisfactory scores (ED app System Usability Scale [SUS], mean 78.6/100, SD 24.1; User Engagement Scale, mean 3.74/5, SD 0.72; patient app SUS, mean 81.7/100, SD 20.1). After refining the apps based on participant feedback, the second cycle testing (n=5) showed improvement (ED app SUS, mean 90.5/100, SD 9.9; User Engagement Scale, mean 4.07/5, SD 0.36; patient app SUS, mean 97.0/100, SD 1.9). The quality ratings for completed safety plans were satisfactory (Safety Planning Intervention Scoring Algorithm-Brief, mean 27.4, SD 3.4).CONCLUSIONS:By adopting a user-centered approach and creating personas to guide development, we were able to create apps for ED patients with suicide risk and obtain satisfactory usability, engagement, and quality scores. Developing digital health tools based on user-centered design principles that deliver evidence-based intervention components may help overcome trenchant implementation barriers in challenging health care settings.

The objective of this study is to assess the effectiveness of wearable cooling in improving thermal comfort for a warm environment that would become prevalent due to more frequent extreme weather events, especially when air conditioning is not accessible for many developing countries. The experiment was conducted in an environment room with air temperature maintained at 31 °C and relative humidity at 55

Remote-controlled robots can perform common tasks, thereby minimizing the exposure to the risks faced by employees in hazardous occupations. The focus of the review in this paper is on the user evaluation of teleoperation interfaces of service robots used in organizational/professional settings. Our study is motivated by the lack of review of user evaluation methods and metrics specific to teleoperation interfaces rather than an evaluation of the robot itself. Grounded in a user-centered approach to design, the three research questions in this review were guided by the three major factors that form the design space for product and service development (Context, Technology, User). The findings of this article are categorized based on areas of application or context of use, technologies used to operate the interfaces, and tools and techniques used to assess user needs as well as user perception of developed solutions. Based on the reported findings, the article provides suggestions for future research that aims at designing interfaces for human-robot collaborations in the workplace.

The purpose of this study is to investigate the combined impact of mask-wearing on cognitive performance and risk-taking behaviors. Participants were divided into a control group (N = 24) without and an experimental group (N = 27) with a surgical mask. Both groups completed the tasks in a warm environment (30 °C) where the conditions can reduce cognition and decision-making as well. These conditions are common in indoor spaces without sufficient air conditioning during a heat wave. Cognition and risk-taking behaviors were assessed using computerized tests. Results showed that mask-wearing in warm environment did not negatively impact cognitive performance, nor did it increase risk-taking behavior as the concept of risk compensation predicts, even when the CO2 concentration was elevated to approximately 29,000 ppm on average inside the mask. On the contrary, mask-wearing participants showed less risk-taking behaviors, slightly better response inhibition and better short-term memory. These results do not support previous findings suggesting that even a moderately increased indoor CO2 level can reduce cognition. We hypothesize that human adaptation effects (due to mask-wearing on a daily basis) make people less vulnerable to the adverse environment (i.e., excessive air temperature and CO2 levels), which will be investigated in the future studies.

BACKGROUND:Emergency departments (EDs) manage many patients with suicide risk, but effective interventions for suicidality are challenging to implement in this setting. ReachCare is a technology-facilitated version of an evidence-based intervention for suicidal ED patients. Here, we present findings on the acceptability and quality of ReachCare in the ED, as well as a comparison of these measures across 3 potential delivery modalities.OBJECTIVE:Our aim was to test the feasibility of the ReachCare intervention in its entirety through conducting a pilot study with patients presenting with suicidality to the ED. We tested three different ways of receiving the ED-based components of ReachCare: (1) self-administered on the tablet app using a chatbot interface, (2) administered by an in-person clinician, or (3) administered by a telehealth clinician.METHODS:In total, 47 ED patients who screened positive for suicide risk were randomly allocated to receive one of three delivery modalities of ReachCare in the ED: (1) self-administered on the patient-facing tablet app with a chatbot interface, (2) delivered by an in-person clinician, or (3) delivered by a telehealth clinician, with the latter two using a clinician-facing web app. We measured demographic and clinical characteristics, acceptability and appropriateness of the intervention, and quality and completeness of the resulting safety plans.RESULTS:Patients assigned high ratings for the acceptability (median 4.00/5, IQR 4.00-4.50) and appropriateness (median 4.00/5, IQR 4.00-4.25) of ReachCare's ED components, and there were no substantial differences across the 3 delivery modalities [H(acceptability)=3.90, P=.14; H(appropriateness)=1.05, P=.59]. The self-administered modality took significantly less time than the 2 clinician modalities (H=27.91, P<.001), and the usability of the self-administered version was in the "very high" range (median 93.75/100, IQR 80.00-97.50). The safety plans created across all 3 modalities were high-quality (H=0.60, P=.74).CONCLUSIONS:Patients rated ReachCare in the ED as highly acceptable and appropriate regardless of modality. Self-administration may be a feasible way to ensure patients with suicide risk receive an intervention in resource constrained EDs. Limitations include small sample size and demographic differences between those enrolled versus not enrolled. Further research will examine the clinical outcomes of patients receiving both the in-ED and post-ED components of ReachCare.TRIAL REGISTRATION:ClinicalTrials.gov NCT04720911; https://clinicaltrials.gov/ct2/show/NCT04720911.