Using the Technology Acceptance Model to Develop StartSmart: mHealth for Screening, Brief Intervention, and Referral for Risk and Protective Factors in Pregnancy
Using the Technology Acceptance Model to Develop StartSmart: mHealth for Screening, Brief Intervention, and Referral for Risk and Protective Factors in Pregnancy
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DOI：
10.1111/jmwh.13009
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发表时间：
2019-07-26
影响因子：
2.7
通讯作者：
Ozkaynak, Mustafa
中科院分区：
文献类型：
--
作者：
Gance-Cleveland, Bonnie;Leiferman, Jenn;Ozkaynak, Mustafa
技术决策支持与量身定制的患者教育有可能改善孕产妇和儿童的健康结果。本研究的目的是开发StartSmart，一种移动的健康（mHealth）干预措施，以支持基于证据的产前筛查，简短的干预，并转介到怀孕的风险和保护因素的治疗。方法StartSmart采用Davis的技术接受模型，最终用户参与了从最初概念到临床测试的技术开发。该原型是根据当前的指南，焦点小组的调查结果，以及与患者和提供者专家的协商而开发的。然后，临床医生和患者对原型进行了alpha测试。临床医生被要求提供反馈的筛选问题，治疗，简短的动机访谈，转诊算法，和个性化的教育材料。临床医生被问及使用这些材料提供简短干预或转诊治疗的可行性。患者接受了采访，使用大声思考技术，一种认知工程方法，用于告知mHealth干预措施的设计。访谈问题以筛选、简短干预、转诊治疗理论为指导，注重有用性和可用性。结果专家临床医生提供的筛选工具，资源和实践指南的指导。临床医生建议为筛查确定特定的产前访视（首次产前访视、28周访视和36周访视）。患者报告说，基于平板电脑的筛查有助于促进对指南的遵守，并提供了改进建议，包括更多关于糖尿病饮食的信息和更多的糖尿病资源。在alpha测试期间，参与者对导航性和可用性进行了评论。患者报告了对问题措辞和易用性的良好反应。讨论临床医生报告说，使用mHealth筛查和咨询怀孕患者的风险和保护因素有助于他们提供全面护理的能力。
Introduction Technology decision support with tailored patient education has the potential to improve maternal and child health outcomes. The purpose of this study was to develop StartSmart, a mobile health (mHealth) intervention to support evidence-based prenatal screening, brief intervention, and referral to treatment for risk and protective factors in pregnancy. Methods StartSmart was developed using Davis' Technology Acceptance Model with end users engaged in the technology development from initial concept to clinical testing. The prototype was developed based upon the current guidelines, focus group findings, and consultation with patient and provider experts. The prototype was then alpha tested by clinicians and patients. Clinicians were asked to give feedback on the screening questions, treatment, brief motivational interviewing, referral algorithms, and the individualized education materials. Clinicians were asked about the feasibility of using the materials to provide brief intervention or referral to treatment. Patients were interviewed using the think aloud technique, a cognitive engineering method used to inform the design of mHealth interventions. Interview questions were guided by the Screening, Brief Intervention, Referral to Treatment theory and attention to usefulness and usability. Results Expert clinicians provided guidance on the screening instruments, resources, and practice guidelines. Clinicians suggested identifying specific prenatal visits for the screening (first prenatal visit, 28-week visit, and 36-week visit). Patients reported that the tablet-based screening was useful to promote adherence to guidelines and provided suggestions for improvement including more information on the diabetic diet and more resources for diabetes. During alpha testing, participants commented on navigability and usability. Patients reported favorable responses about question wording and ease of use. Discussion Clinicians reported the use of mHealth to screen and counsel pregnant patients on risk and protective factors facilitated their ability to provide comprehensive care.