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Home Healthcare, Hospice, and Information Technology Innovations Conference

Innovations in Home Healthcare, Hospice, and Information Technology

A forum towards achieving evidence-based diffusion and implementation of innovations

Fri, Nov 3, 2017
Friday, Nov 3, 2017, Washington - D.C.
H3IT: Home Healthcare, Hospice, and Information Technology Conference Chicago, IL, 2016
Accessibility and Beyond: Designing Consumer
Health IT for Individuals with Disabilities
Rupa S. Valdez, PhD
(rsv9d@virginia.edu), Melissa R. Lemke, MS
(lemkemr@humanabilitydesigns.com), Georey R. Smith,
(gs4gd@virginia.edu), Claire A. Wellbeloved-Stone, MPH
s health care shifts to home- and community-based settings
the roles of both providers and patients are trans-
There has been an increasing focus on consumer health IT (CHIT) (i.e., electronic technology used
by laypeople to support health and health care management) to address this shift in health care.
living with physical, cognitive, and/or sensory disabilities face challenges engaging in CHIT and have not been
a demographic focus of developers.
Approximately one-fth of the non-institutionalized U.S. population self-identies as
With such a large portion of the population identifying as disabled it will be necessary to develop CHIT with this
demographic in mind. This study aims to assess the needs of individuals with disabilities for CHIT focused on one technology
platform (mHealth) and one self-management task (health information communication with social network members). This
will be accomplished through a multi-method study that explicates individuals with disabilities’ existing health information
communication practices and the accessibility, usability, and usefulness of three existing mHealth solutions incorporating
health information communication functionalities.
Methods: There are three phases in this two-year longitudinal study: (1) interview-based exploration of existing health
information communication practices, (2) task analysis and journal-based exploration of challenges to using existing con-
sumer health IT incorporating health information communication functionalities, and (3) design session-based exploration of
potential design solutions. The study will involve 60 participants living with physical (n=20), sensory (n=20), and cognitive
(n=20) disabilities. In Phase 1 participants are involved in a semi-structured interview about their personal network and
health information sharing—including use of CHIT for health information communication. In Phase 2 participants interact
with three existing mHealth apps focused on health information communication on either an iPad or iPhone: (1) Microsoft
HealthVault (non-tethered PHR), (2) Epic’s MyChart (tethered PHR), and (3) CaringBridge (social support). In Phase 3
participants attend group design sessions to discuss mHealth app design focused on health information communication as
well as access ibility challenges of mHealth apps and how to overcome them in future design.
Results: To date we have screened 29 individuals, interviewed XX, and conducted task analysis with 4. Initial analysis of
interviews has shown that most participants rarely use CHIT to communicate health information. Instead, they mainly use
the telephone or communicate in person. Their networks tend to be small (range: n=3-47, mean: n=11, median: n=8).
Many participants are not opposed to using CHIT, but have never learned how or do not have access. The pilot data from
Phase 2 led to initial ndings about the usability and accessibility of the three mHealth apps. HealthVault and MyChart do
not have iPad versions. It is not possible to click the sign up button in HealthVault on the iPad, making it non-functional on
the iPad. Additionally, there are limitations with the voiceover function’s interface with the apps. For example, the terms
and conditions text was not read out on the CaringBridge app, there was no voiceover indication when a pop-up appeared,
and it was dicult for the user to tell what she had entered into the email text eld. By the symposium we will have a more
robust dataset and more results to present.
Discussion: The initial results show that there are still large gaps between CHIT developers and the needs of individuals
with physical, cognitive, and/or sensory disabilities. After collecting and analyzing data from all 60 participants we will
develop guidelines for app development that address this population’s needs. Simple modications, such as ensuring that alt
text is available for photos and that the screen ips orientation to landscape, could reduce user burden. A limitation of the
study is that the design guidance to be generated is anchored in one technology platform and three specic mHealth apps.
Conclusion: Engaging with people living with physical, cognitive, and/or sensory disabilities will allow us insight into user
needs and preferences for CHIT. Through mixed methods we hope to use existing mHealth apps to inform design guidance
and increase the accessibility and usability of future mHealth apps as health care shifts to home- and community-based
Acknowledgments: This research is supported by the Agency for Healthcare Research and Quality (AHRQ) under award
number 1 R21 HS023849-01. The content is solely the responsibility of the authors and does not necessarily represent the
ocial views of AHRQ.
University of Virginia, Charlottesville, VA
Human Ability Designs, Canton, MI
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H3IT: Home Healthcare, Hospice, and Information Technology Conference Chicago, IL, 2016
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