@article{KernebeckHollePogschebaetal.2019, author = {Kernebeck, Sven and Holle, Daniela and Pogscheba, Patrick and Jordan, Felix and Mertl, Fabian and Huldtgren, Alina and Bader, Sebastian and Kirste, Thomas and Teipel, Stefan and Holle, Bernhard and Halek, Margareta}, title = {A Tablet App- and Sensor-Based Assistive Technology Intervention for Informal Caregivers to Manage the Challenging Behavior of People With Dementia (the insideDEM Study): Protocol for a Feasibility Study}, series = {JMIR Research Protocols}, volume = {8}, journal = {JMIR Research Protocols}, issn = {1929-0748}, doi = {10.25974/fhms-17327}, url = {http://nbn-resolving.de/urn:nbn:de:hbz:836-opus-173274}, pages = {e11630}, year = {2019}, abstract = {Despite the enormous number of assistive technologies (ATs) in dementia care, the management of challenging behavior (CB) of persons with dementia (PwD) by informal caregivers in home care is widely disregarded. The first-line strategy to manage CB is to support the understanding of the underlying causes of CB to formulate individualized nonpharmacological interventions. App- and sensor-based approaches combining multimodal sensors (actimetry and other modalities) and caregiver information are innovative ways to support the understanding of CB for family caregivers. The main aim of this study is to describe the design of a feasibility study consisting of an outcome and a process evaluation of a newly developed app- and sensor-based intervention to manage CB of PwD for family caregivers at home. In this feasibility study, we perform an outcome and a process evaluation with a pre-post descriptive design over an 8-week intervention period. The Medical Research Council framework guides the design of this feasibility study. The data on 20 dyads (primary caregiver and PwD) are gathered through standardized questionnaires, protocols, and log files as well as semistructured qualitative interviews. The outcome measures (neuropsychiatric inventory and Cohen-Mansfield agitation inventory) are analyzed by using descriptive statistics and statistical tests relevant to the individual assessments (eg, chi-square test and Wilcoxon signed-rank test). For the analysis of the process data, the Unified Theory of Acceptance and Use of Technology is used. Log files are analyzed by using descriptive statistics, protocols are analyzed by using documentary analysis, and semistructured interviews are analyzed deductively using content analysis. The newly developed app- and sensor-based AT has been developed and was evaluated until July in 2018. The recruitment of dyads started in September 2017 and was concluded in March 2018. The data collection was completed at the end of July 2018. This study presents the protocol of the first feasibility study to encompass an outcome and process evaluation to assess a complex app- and sensor-based AT combining multimodal actimetry sensors for informal caregivers to manage CB. The feasibility study will provide in-depth information about the study procedure and on how to optimize the design of the intervention and its delivery. DERR1-10.2196/11630}, language = {en} } @article{KernebeckHollePogschebaetal.2019, author = {Kernebeck, Sven and Holle, Daniela and Pogscheba, Patrick and Jordan, Felix and Mertl, Fabian and Huldtgren, Alina and Bader, Sebastian and Kirste, Thomas and Teipel, Stefan and Holle, Bernhard and Halek, Margareta}, title = {A Tablet App- and Sensor-Based Assistive Technology Intervention for Informal Caregivers to Manage the Challenging Behavior of People With Dementia (the insideDEM Study): Protocol for a Feasibility Study (Preprint)}, series = {JMIR Res Protoc}, volume = {8}, journal = {JMIR Res Protoc}, number = {2}, doi = {10.25974/fhms-17306}, url = {http://nbn-resolving.de/urn:nbn:de:hbz:836-opus-173061}, year = {2019}, abstract = {BACKGROUND Despite the enormous number of assistive technologies (ATs) in dementia care, the management of challenging behavior (CB) of persons with dementia (PwD) by informal caregivers in home care is widely disregarded. The first-line strategy to manage CB is to support the understanding of the underlying causes of CB to formulate individualized nonpharmacological interventions. App- and sensor-based approaches combining multimodal sensors (actimetry and other modalities) and caregiver information are innovative ways to support the understanding of CB for family caregivers. OBJECTIVE The main aim of this study is to describe the design of a feasibility study consisting of an outcome and a process evaluation of a newly developed app- and sensor-based intervention to manage CB of PwD for family caregivers at home. METHODS In this feasibility study, we perform an outcome and a process evaluation with a pre-post descriptive design over an 8-week intervention period. The Medical Research Council framework guides the design of this feasibility study. The data on 20 dyads (primary caregiver and PwD) are gathered through standardized questionnaires, protocols, and log files as well as semistructured qualitative interviews. The outcome measures (neuropsychiatric inventory and Cohen-Mansfield agitation inventory) are analyzed by using descriptive statistics and statistical tests relevant to the individual assessments (eg, chi-square test and Wilcoxon signed-rank test). For the analysis of the process data, the Unified Theory of Acceptance and Use of Technology is used. Log files are analyzed by using descriptive statistics, protocols are analyzed by using documentary analysis, and semistructured interviews are analyzed deductively using content analysis. RESULTS The newly developed app- and sensor-based AT has been developed and was evaluated until July in 2018. The recruitment of dyads started in September 2017 and was concluded in March 2018. The data collection was completed at the end of July 2018. CONCLUSIONS This study presents the protocol of the first feasibility study to encompass an outcome and process evaluation to assess a complex app- and sensor-based AT combining multimodal actimetry sensors for informal caregivers to manage CB. The feasibility study will provide in-depth information about the study procedure and on how to optimize the design of the intervention and its delivery. INTERNATIONAL REGISTERED REPOR DERR1-10.2196/11630}, language = {de} } @article{KernebeckBusseEhlersetal.2021, author = {Kernebeck, Sven and Busse, Theresa Sophie and Ehlers, Jan Peter and Vollmar, Horst Christian}, title = {Adh{\"a}renz digitaler Interventionen im Gesundheitswesen: Definitionen, Methoden und offene Fragen}, series = {Bundesgesundheitsblatt - Gesundheitsforschung - Gesundheitsschutz}, volume = {64}, journal = {Bundesgesundheitsblatt - Gesundheitsforschung - Gesundheitsschutz}, issn = {1436-9990}, doi = {10.25974/fhms-17318}, url = {http://nbn-resolving.de/urn:nbn:de:hbz:836-opus-173188}, pages = {1278 -- 1284}, year = {2021}, abstract = {AbstractMany digital interventions rely on the participation of their users to have a positive impact. In various areas it can be observed that the use of digital interventions is often reduced or fully discontinued by the users after a short period of time. This is seen as one of the main factors that can limit the effectiveness of digital interventions. In this context, the concept of adherence to digital interventions is becoming increasingly important. Adherence to digital interventions is roughly defined as "the degree to which the user followed the program as it was designed," which can also be paraphrased as "intended use" or "use as it is designed." However, both the theoretical-conceptual and practical discussions regarding adherence to digital interventions still receive too little attention.The aim of this narrative review article is to shed more light on the concept of adherence to digital interventions and to distinguish it from related concepts. It also discusses the methods and metrics that can be used to operationalize adherence and the predictors that positively influence adherence. Finally, needs for action to better address adherence are considered critically.}, language = {en} } @article{BusseNitscheKernebecketal.2022, author = {Busse, Theresa Sophie and Nitsche, Julia and Kernebeck, Sven and Jux, Chantal and Weitz, J{\"u}rgen and Ehlers, Jan P. and Bork, Ulrich}, title = {Approaches to Improvement of Digital Health Literacy (eHL) in the Context of Person-Centered Care}, series = {International Journal of Environmental Research and Public Health}, volume = {19}, journal = {International Journal of Environmental Research and Public Health}, issn = {1661-7827}, doi = {10.25974/fhms-17311}, url = {http://nbn-resolving.de/urn:nbn:de:hbz:836-opus-173115}, pages = {8309}, year = {2022}, abstract = {The skills, knowledge and resources to search for, find, understand, evaluate and apply health information is defined as health literacy (HL). If individuals want to use health information from the Internet, they need Digital Health Literacy (eHL), which in addition to HL also includes, for example, media literacy. If information cannot be found or understood by patients due to low (e)HL, patients will not have the opportunity to make informed decisions. In addition, many health apps for self-management or prevention also require (e)HL. Thus, it follows that active participation in healthcare, in terms of Person-Centered Care (PCC) is only possible through (e)HL. Currently, there is a great need to strengthen these competencies in society to achieve increased empowerment of patients and their health. However, at the same time, there is a need to train and improve competencies in the field of healthcare professionals so that they can counsel and guide patients. This article provides an overview with a focus on HL and eHL in healthcare, shows the opportunities to adapt services and describes the possible handling of patients with low (e)HL. In addition, the opportunities for patients and healthcare professionals to improve (e)HL are highlighted.}, language = {de} } @article{KernebeckKramerRedaellietal.2021, author = {Kernebeck, Sven and Kramer, Ursula and Redaelli, Marcus and Vollmar, Horst Christian}, title = {Bewerten, aber wie? - Kriterien f{\"u}r die Evaluation und das Reporting von Studien zu Gesundheits- und Medizin-Apps}, series = {Monitor Versorgungsforschung}, volume = {14}, journal = {Monitor Versorgungsforschung}, number = {2}, doi = {10.25974/fhms-17325}, url = {http://nbn-resolving.de/urn:nbn:de:hbz:836-opus-173256}, year = {2021}, language = {en} } @article{MeyerKernebeckBusseetal.2021, author = {Meyer, Dorothee and Kernebeck, Sven and Busse, Theresa Sophie and Ehlers, Jan and Wager, Julia and Zernikow, Boris and Dreier, Larissa Alice}, title = {Electronic Health Records in Specialized Pediatric Palliative Care: A Qualitative Needs Assessment among Professionals Experienced and Inexperienced in Electronic Documentation}, series = {Children}, volume = {8}, journal = {Children}, issn = {2227-9067}, doi = {10.25974/fhms-17326}, url = {http://nbn-resolving.de/urn:nbn:de:hbz:836-opus-173265}, pages = {249}, year = {2021}, abstract = {Background: Currently, to the best of our knowledge, no findings exist concerning the needs of professionals in specialized pediatric palliative care (PPC) regarding electronic health records (EHRs). Several studies have highlighted benefits concerning the use of EHRs in pediatrics. However, usability is strongly affected by the degree of adaptivity to the context of application. The aim of this study is to examine the needs of professionals concerning an EHR in the specialized PPC inpatient and outpatient settings. Methods: A qualitative research design was chosen to address the complex aspects of user demands. Focus group interviews and semi-structured one-on-one interviews were conducted with PPC professionals. N = 23 participants from inpatient and N = 11 participants from outpatient settings of specialized PPC representing various professions took part in the study. Results: The findings could be grouped into four categories: (1) attitude towards the current methods of documentation, (2) attitude towards electronic documentation in general, (3) general requirements for an EHR, and (4) content requirements for an EHR. Conclusions: Professionals in specialized PPC expect and experience many benefits of using electronic documentation. Their requirements for an EHR for inpatient and outpatient settings of PPC are largely consistent with EHRs for pediatrics. However, individual specifications and adaptations are necessary for this particular setting.}, language = {en} } @article{KernebeckBusseJuxetal.2022, author = {Kernebeck, Sven and Busse, Theresa Sophie and Jux, Chantal and Dreier, Larissa Alice and Meyer, Dorothee and Zenz, Daniel and Zernikow, Boris and Ehlers, Jan Peter}, title = {Evaluation of an Electronic Medical Record Module for Nursing Documentation in Paediatric Palliative Care: Involvement of Nurses with a Think-Aloud Approach}, series = {International Journal of Environmental Research and Public Health}, volume = {19}, journal = {International Journal of Environmental Research and Public Health}, issn = {1661-7827}, doi = {10.25974/fhms-17313}, url = {http://nbn-resolving.de/urn:nbn:de:hbz:836-opus-173137}, pages = {3637}, year = {2022}, abstract = {Background: Paediatric palliative care (PPC) is a noncurative approach to the care of children and adolescents with life-limiting and life-threatening illnesses. Electronic medical records (EMRs) play an important role in documenting such complex processes. Despite their benefits, they can introduce unintended consequences if future users are not involved in their development. Aim: The aim of this study was to evaluate the acceptance of a novel module for nursing documentation by nurses working in the context of PPC. Methods: An observational study employing concurrent think-aloud and semi-structured qualitative interviews were conducted with 11 nurses working in PPC. Based on the main determinants of the unified theory of acceptance and use of technology (UTAUT), data were analysed using qualitative content analysis. Results: The main determinants of UTAUT were found to potentially influence acceptance of the novel module. Participants perceived the module to be self-explanatory and intuitive. Some adaptations, such as the reduction of fragmentation in the display, the optimization of confusing mouseover fields, and the use of familiar nursing terminology, are reasonable ways of increasing software adoption. Conclusions: After adaptation of the modules based on the results, further evaluation with the participation of future users is required.}, language = {de} } @article{BusseJuxLaseretal.2023, author = {Busse, Theresa Sophie and Jux, Chantal and Laser, Johannes and Rasche, Peter and Vollmar, Horst Christian and Ehlers, Jan P and Kernebeck, Sven}, title = {Involving Health Care Professionals in the Development of Electronic Health Records: Scoping Review}, series = {JMIR Human Factors}, volume = {10}, journal = {JMIR Human Factors}, doi = {10.25974/fhms-17305}, url = {http://nbn-resolving.de/urn:nbn:de:hbz:836-opus-173050}, pages = {e45598}, year = {2023}, abstract = {Electronic health records (EHRs) are a promising approach to document and map (complex) health information gathered in health care worldwide. However, possible unintended consequences during use, which can occur owing to low usability or the lack of adaption to existing workflows (eg, high cognitive load), may pose a challenge. To prevent this, the involvement of users in the development of EHRs is crucial and growing. Overall, involvement is designed to be very multifaceted, for example, in terms of the timing, frequency, or even methods used to capture user preferences. Setting, users and their needs, and the context and practice of health care must be considered in the design and subsequent implementation of EHRs. Many different approaches to user involvement exist, each requiring a variety of methodological choices. The aim of the study was to provide an overview of the existing forms of user involvement and the circumstances they need and to provide support for the planning of new involvement processes. We conducted a scoping review to provide a database for future projects on which design of inclusion is worthwhile and to show the diversity of reporting. Using a very broad search string, we searched the PubMed, CINAHL, and Scopus databases. In addition, we searched Google Scholar. Hits were screened according to scoping review methodology and then examined, focusing on methods and materials, participants, frequency and design of the development, and competencies of the researchers involved. In total, 70 articles were included in the final analysis. There was a wide range of methods of involvement. Physicians and nurses were the most frequently included groups and, in most cases, were involved only once in the process. The approach of involvement (eg, co-design) was not specified in most of the studies (44/70, 63\%). Further qualitative deficiencies in the reporting were evident in the presentation of the competences of members of the research and development teams. Think-aloud sessions, interviews, and prototypes were frequently used. This review provides insights into the diversity of health care professionals' involvement in the development of EHRs. It provides an overview of the different approaches in various fields of health care. However, it also shows the necessity of considering quality standards in the development of EHRs together with future users and the need for reporting this in future studies.}, language = {de} } @article{TeipelHeineHeinetal.2017, author = {Teipel, Stefan and Heine, Christina and Hein, Albert and Kr{\"u}ger, Frank and Kutschke, Andreas and Kernebeck, Sven and Halek, Margareta and Bader, Sebastian and Kirste, Thomas}, title = {Multidimensional assessment of challenging behaviors in advanced stages of dementia in nursing homes—The insideDEM framework}, series = {Alzheimer's \& Dementia: Diagnosis, Assessment \& Disease Monitoring}, volume = {8}, journal = {Alzheimer's \& Dementia: Diagnosis, Assessment \& Disease Monitoring}, issn = {2352-8729}, doi = {10.25974/fhms-17330}, url = {http://nbn-resolving.de/urn:nbn:de:hbz:836-opus-173308}, pages = {36 -- 44}, year = {2017}, abstract = {IntroductionAssessment of challenging behaviors in dementia is important for intervention selection. Here, we describe the technical and experimental setup and the feasibility of long-term multidimensional behavior assessment of people with dementia living in nursing homes.MethodsWe conducted 4 weeks of multimodal sensor assessment together with real-time observation of 17 residents with moderate to very severe dementia in two nursing care units. Nursing staff received extensive training on device handling and measurement procedures. Behavior of a subsample of eight participants was further recorded by videotaping during 4 weeks during day hours. Sensors were mounted on the participants' wrist and ankle and measured motion, rotation, as well as surrounding loudness level, light level, and air pressure.ResultsParticipants were in moderate to severe stages of dementia. Almost 100\% of participants exhibited relevant levels of challenging behaviors. Automated quality control detected 155 potential issues. But only 11\% of the recordings have been influenced by noncompliance of the participants. Qualitative debriefing of staff members suggested that implementation of the technology and observation platform in the routine procedures of the nursing home units was feasible and identified a range of user- and hardware-related implementation and handling challenges.DiscussionOur results indicate that high-quality behavior data from real-world environments can be made available for the development of intelligent assistive systems and that the problem of noncompliance seems to be manageable. Currently, we train machine-learning algorithms to detect episodes of challenging behaviors in the recorded sensor data.}, language = {en} } @article{BusseJuxKernebecketal.2021, author = {Busse, Theresa Sophie and Jux, Chantal and Kernebeck, Sven and Dreier, Larissa Alice and Meyer, Dorothee and Zenz, Daniel and Zernikow, Boris and Ehlers, Jan Peter}, title = {Needs Assessment for the Development of an Electronic Cross-Facility Health Record (ECHR) for Pediatric Palliative Care: A Design Thinking Approach}, series = {Children}, volume = {8}, journal = {Children}, issn = {2227-9067}, doi = {10.25974/fhms-17324}, url = {http://nbn-resolving.de/urn:nbn:de:hbz:836-opus-173245}, pages = {602}, year = {2021}, abstract = {Background: Pediatric palliative care (PPC) is characterized by years of multisectoral and multi-professional care. Sharing information between PPC professionals is, therefore, essential for quality care. The evidence shows that electronic cross-facility health records (ECHRs) provide useful support in this context. To our knowledge, no ECHRs have been developed through a user-centered approach for this specific setting in Germany. Methods: Guided by design thinking, first, qualitative interviews were conducted to assess the needs of PPC professionals. Second, the elicited needs were specified in focus groups (FGs). Based on the needs stated in the interviews, prototypes of the ECHR were developed and discussed in the FGs. The indicated needs were supplemented and specified in an iterative process. The prototypes were further adapted according to these results. The unified theory of acceptance and use of technology was the basic model in the evaluation of needs. Results: Across seven main categories, past and current medication, emergency view, and messaging functions were identified as the participants' desired core components of an ECHR. Utilizing design thinking facilitated the explicit articulation of user needs. Conclusions: Developing an ECHR with the content identified would allow for real-time data during emergencies, tracking what other PPC professionals have done, and making the applied treatments visible to others. This would offer a broader picture of the complex conditions common to PPC.}, language = {en} }