Appl Clin Inform 2017; 08(01): 191-205
DOI: 10.4338/ACI-2016-07-RA-0122
Research Article
Schattauer GmbH

Getting what they need when they need it

Identifying barriers to information needs of family caregivers to manage dementia-related behavioral symptoms
Nicole E. Werner
1   Department of Industrial and Systems Engineering, College of Engineering, University of Wisconsin-Madison, Madison, Wisconsin
2   Center for Quality and Productivity Improvement, College of Engineering, University of Wisconsin-Madison, Madison, Wisconsin
3   Wisconsin Institute for Discovery, University of Wisconsin-Madison, Madison, Wisconsin
,
Barbara Stanislawski
4   Department of Psychiatry, University of Michigan
,
Katherine A. Marx
5   School of Nursing, Johns Hopkins University
6   Center for Innovative Care in Aging, Johns Hopkins University
,
Daphne C. Watkins
4   Department of Psychiatry, University of Michigan
,
Marissa Kobayashi
5   School of Nursing, Johns Hopkins University
6   Center for Innovative Care in Aging, Johns Hopkins University
,
Helen Kales
4   Department of Psychiatry, University of Michigan
,
Laura N. Gitlin
4   Department of Psychiatry, University of Michigan
5   School of Nursing, Johns Hopkins University
7   Department of Psychiatry (Joint Appointment), Johns Hopkins School of Medicine
› Institutsangaben
Funding This research was supported by funding from the National Institutes of Health (NIH Grant #5R01NR014200-03). The funders had no role in any of the following activities: design and conduct of the study; collection, management, analysis, and interpretation of the data; and preparation, review, or approval of the manuscript.
Weitere Informationen

Correspondence to:

Nicole E Werner, Ph.D., Assistant Professor
Department of Industrial and Systems Engineering
Discovery Fellow, Living Environments Laboratory, Wisconsin Institute for Discovery
Affiliate Faculty, Center for Quality and Productivity Improvement
Affiliate Faculty, William S Middleton Memorial VA Hospital
University of Wisconsin-Madison
1513 University Avenue Madison, WI 53706
Telefon: 608.890.2578   
Fax: 608.262.8454   

Publikationsverlauf

Received: 24. Juli 2016

Accepted: 09. Februar 2016

Publikationsdatum:
20. Dezember 2017 (online)

 

Summary

Background: Consumer health informatics (CHI) such as web-based applications may provide the platform for enabling the over 15 million family caregivers of patients with Alzheimer’s Disease or related dementias the information they need when they need it to support behavioral symptom management. However, for CHI to be successful, it is necessary that it be designed to meet the specific information needs of family caregivers in the context in which caregiving occurs. A sociotechnical systems approach to CHI design can help to understand the contextual complexities of family caregiving and account for those complexities in the design of CHI for family caregivers. Objectives: This study used a sociotechnical systems approach to identify barriers to meeting care-givers’ information needs related to the management of dementia-related behavioral symptoms, and to derive design implications that overcome barriers for caregiver-focused web-based platforms. We have subsequently used these design implications to inform the development of a web-based platform, WeCareAdvisor,TM which provides caregivers with information and an algorithm by which to identify and manage behavioral symptoms for which they seek management strategies.

Methods: We conducted 4 focus groups with family caregivers (N=26) in a Midwestern state. Qualitative content analysis of the data was guided by a sociotechnical systems framework. Results: We identified nine categories of barriers that family caregivers confront in obtaining needed information about behavioral symptom management from which we extrapolated design implications for a web-based platform. Based on interactions within the sociotechnical system, three critical information needs were identified: 1) timely access to information, 2) access to information that is tailored or specific to caregiver’s needs and contexts, and 3) usable information that can directly inform how caregivers’ manage behaviors.

Conclusions: The sociotechnical system framework is a useful approach for identifying information needs of family caregivers to inform design of web-based platforms that are user-centered.


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Conflict of Interest Statement

The authors declare that they have no conflicts of interest in the research.

  • References

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  • 2 Allegri RF, Sarasola D, Serrano CM, Taragano FE, Arizaga RL, Butman J, Loñ L. Neuropsychiatric symptoms as a predictor of caregiver burden in Alzheimer’s disease. Neuropsychiatric Disease and Treatment 2006; 2 (Suppl. 01) 105.
  • 3 Gaugler JE, Yu F, Krichbaum K, Wyman JF. Predictors of nursing home admission for persons with dementia. Medical care 2009; 47 (Suppl. 02) 191-198.
  • 4 Brodaty H, Connors MH, Xu J, Woodward M, Ames D, Group PS. The course of neuropsychiatric symptoms in dementia: A 3-year longitudinal study. Journal of the American Medical Directors Association 2015; 16 (Suppl. 05) 380-387.
  • 5 Gitlin LN, Kales HC, Lyketsos CG. Nonpharmacologic management of behavioral symptoms in dementia. JAMA 2012; 308 (Suppl. 19) 2020-2029.
  • 6 Steinberg M, Shao H, Zandi P, Lyketsos CG, Welsh-Bohmer KA, Norton MC, Breitner JC, Steffens DC, Tschnz JT. Cache Couty Investigators.. Point and 5-year period prevalence of neuropsychiatric symptoms in dementia: the Cache County Study. International journal of geriatric psychiatry 2008; 23 (Suppl. 02) 170.
  • 7 Steiner V, Pierce LL, Salvador D. Information Needs of Family Caregivers of People With Dementia.. Rehabil Nurs.. 2015
  • 8 American Medical Informatics Association.. Consumer health informatics. cited 2016 December 6. Available from: https://www.amia.org/applications-informatics/consumer-health-informatics.
  • 9 Walker JM, Carayon P. From tasks to processes: the case for changing health information technology to improve health care. Health Aff (Millwood) 2009; 28 (Suppl. 02) 467-477. doi: 10.1377/hlthaff.28.2.467. PubMed PMID: 19276006.
  • 10 Wilson JR, Corlett N, Wilson J, Haines H, Morris W. Participatory ergonomics. Evaluation of Human Work. 3rd Edition CRC Press; 2005: 933-962.
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  • 16 Novak LL, Holden RJ, Anders SH, Hong JY, Karsh BT. Using a sociotechnical framework to understand adaptations in health IT implementation. International journal of medical informatics 2013; 82 (Suppl. 12) e331-e344. Epub 2013/04/09. doi: S1386-5056(13)00020-8 [pii]10.1016/j.ijmedinf.2013.01.009 [doi]. PubMed PMID: 23562140; PubMed Central PMCID: PMCPMC3772996.
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  • 19 Holden RJ, Karsh B-T. A review of medical error reporting system design considerations and a proposed cross-level systems research framework. Human Factors: The Journal of the Human Factors and Ergo-nomics Society 2007; 49 (Suppl. 02) 257-276.
  • 20 Carayon P. A longitudinal study of job design and worker strain: Preliminary results.. Quick JC, Murphy LR, Hurrell JJ. (Eds.), editor. Washington, DC: American Psychological Association; 1992
  • 21 Wright A, Phansalkar S, Bloomrosen M, Jenders RA, Bobb AM, Halamka JD, Keuperman G, Payne TH, Teasdale S, Vaida AJ, Bates DW. Best practices in clinical decision support: The case of preventive care reminders. Appl Clin Inform 2010; 1 (Suppl. 03) 331-345.
  • 22 Kales HC, Gitlin LN, Lyketsos CG. Management of neuropsychiatric symptoms of dementia in clinical settings: recommendations from a multidisciplinary expert panel. Journal of the American Geriatrics Society 2014; 62 (Suppl. 04) 762-769.
  • 23 Kales HC, Gitlin LN, Lyketsos CG. State of the Art Review: Assessment and management of behavioral and psychological symptoms of dementia. BMJ: British Medical Journal 2015; 350.
  • 24 Crabtree BF, Miller WL. Doing qualitative research. Sage Publications; 1999
  • 25 Lucero R, Sheehan B, Yen P, Velez O, Nobile-Hernandez D, Tiase V. Identifying consumer’s needs of health information technology through an innovative participatory design approach among English-and Spanish-speaking urban older adults. Applied clinical informatics 2014; 5 (Suppl. 04) 943-957.
  • 26 Mickan S, Tilson JK, Atherton H, Roberts NW, Heneghan C. Evidence of effectiveness of health care professionals using handheld computers: a scoping review of systematic reviews. Journal of medical Internet research 2013; 15 (Suppl. 10) e212.
  • 27 Kreuter MW, Farrell DW, Olevitch LR, Brennan LK. Tailoring health messages: Customizing communication with computer technology. Routledge; 2013
  • 28 Civljak M, Stead LF, Hartmann-Boyce J, Sheikh A, Car J. Internet-based interventions for smoking cessation. Cochrane Database Syst Rev 2013; 7.
  • 29 Strecher VJ, Shiffman S, West R. Randomized controlled trial of a web[uni2010]based computer[uni2010]tailored smoking cessation program as a supplement to nicotine patch therapy. Addiction 2005; 100 (Suppl. 05) 682-688.
  • 30 Hutton HE, Wilson LM, Apelberg BJ, Tang EA, Odelola O, Bass EB, Chander G. A systematic review of randomized controlled trials: Web-based interventions for smoking cessation among adolescents, college students, and adults. Nicotine & Tobacco Research 2011; 13 (Suppl. 04) 227-238.
  • 31 Boots LM, Wolfs CA, Verhey FR, Kempen GI, de Vugt ME. Qualitative study on needs and wishes of early-stage dementia caregivers: the paradox between needing and accepting help. International Psychogeriatrics 2015; 27 (Suppl. 06) 927-936.
  • 32 Washington KT, Meadows SE, Elliott SG, Koopman RJ. Information needs of informal caregivers of older adults with chronic health conditions. Patient Educ Couns 2011; 83 (Suppl. 01) 37-44.
  • 33 Wald C, Fahy M, Walker Z, Livingston G. What to tell dementia caregivers—the rule of threes. Int J Geriatr Psychiatry 2003; 18 (Suppl. 04) 313-317.
  • 34 Camerini L, Camerini A-L, Schulz PJ. Do participation and personalization matter? A model-driven evaluation of an Internet-based patient education intervention for fibromyalgia patients. Patient Educ Couns 2013; 92 (Suppl. 02) 229-234.
  • 35 van Gemert-Pijnen JE, Nijland N, van Limburg M, Ossebaard HC, Kelders SM, Eysenbach G, Seydel ER. A holistic framework to improve the uptake and impact of eHealth technologies. J Med Internet Res 2011; 13 (Suppl. 04) e111.

Correspondence to:

Nicole E Werner, Ph.D., Assistant Professor
Department of Industrial and Systems Engineering
Discovery Fellow, Living Environments Laboratory, Wisconsin Institute for Discovery
Affiliate Faculty, Center for Quality and Productivity Improvement
Affiliate Faculty, William S Middleton Memorial VA Hospital
University of Wisconsin-Madison
1513 University Avenue Madison, WI 53706
Telefon: 608.890.2578   
Fax: 608.262.8454   

  • References

  • 1 Alzheimer’s Association.. 2015 Alzheimer’s disease facts and figures. Alzheimer’s & dementia: the journal of the Alzheimer’s Association 2015; 11 (Suppl. 03) 332.
  • 2 Allegri RF, Sarasola D, Serrano CM, Taragano FE, Arizaga RL, Butman J, Loñ L. Neuropsychiatric symptoms as a predictor of caregiver burden in Alzheimer’s disease. Neuropsychiatric Disease and Treatment 2006; 2 (Suppl. 01) 105.
  • 3 Gaugler JE, Yu F, Krichbaum K, Wyman JF. Predictors of nursing home admission for persons with dementia. Medical care 2009; 47 (Suppl. 02) 191-198.
  • 4 Brodaty H, Connors MH, Xu J, Woodward M, Ames D, Group PS. The course of neuropsychiatric symptoms in dementia: A 3-year longitudinal study. Journal of the American Medical Directors Association 2015; 16 (Suppl. 05) 380-387.
  • 5 Gitlin LN, Kales HC, Lyketsos CG. Nonpharmacologic management of behavioral symptoms in dementia. JAMA 2012; 308 (Suppl. 19) 2020-2029.
  • 6 Steinberg M, Shao H, Zandi P, Lyketsos CG, Welsh-Bohmer KA, Norton MC, Breitner JC, Steffens DC, Tschnz JT. Cache Couty Investigators.. Point and 5-year period prevalence of neuropsychiatric symptoms in dementia: the Cache County Study. International journal of geriatric psychiatry 2008; 23 (Suppl. 02) 170.
  • 7 Steiner V, Pierce LL, Salvador D. Information Needs of Family Caregivers of People With Dementia.. Rehabil Nurs.. 2015
  • 8 American Medical Informatics Association.. Consumer health informatics. cited 2016 December 6. Available from: https://www.amia.org/applications-informatics/consumer-health-informatics.
  • 9 Walker JM, Carayon P. From tasks to processes: the case for changing health information technology to improve health care. Health Aff (Millwood) 2009; 28 (Suppl. 02) 467-477. doi: 10.1377/hlthaff.28.2.467. PubMed PMID: 19276006.
  • 10 Wilson JR, Corlett N, Wilson J, Haines H, Morris W. Participatory ergonomics. Evaluation of Human Work. 3rd Edition CRC Press; 2005: 933-962.
  • 11 Wilson JR, Cordiner LA, Nichols SC, Norton L, Bristol N, Clarke T, and Roberts S. On the right track: systematic implementation of ergonomics in railway network control. Cognition, Technology, and Work 2001; 3: 238-252.
  • 12 Wilson JR. Fundamentals of ergonomics in theory and practice. Applied ergonomics 2000; 31 (Suppl. 06) 557-567.
  • 13 Carayon P, Hundt AS, Karsh B, Gurses A, Alvarado C, Smith M, Brennan PF. Work system design for patient safety: the SEIPS model. Quality and Safety in Health Care 2006; 15 (Suppl. 01) i50-i58.
  • 14 Holden RJ, Carayon P, Gurses AP, Hoonakker P, Hundt AS, Ozok AA, Rivera-Rodriguez JA. SEIPS 2.0: a human factors framework for studying and improving the work of healthcare professionals and patients. Ergonomics 2013; 56 (Suppl. 11) 1669-1686.
  • 15 Karsh B-T. Beyond usability: Designing effective technology implementation systems to promote patient safety. Quality and Safety in Health Care 2004; 13 (Suppl. 05) 388-394. PubMed PMID: 15465944; PubMed Central PMCID: PMCPMC1743880.
  • 16 Novak LL, Holden RJ, Anders SH, Hong JY, Karsh BT. Using a sociotechnical framework to understand adaptations in health IT implementation. International journal of medical informatics 2013; 82 (Suppl. 12) e331-e344. Epub 2013/04/09. doi: S1386-5056(13)00020-8 [pii]10.1016/j.ijmedinf.2013.01.009 [doi]. PubMed PMID: 23562140; PubMed Central PMCID: PMCPMC3772996.
  • 17 Or CK, Valdez RS, Casper GR, Carayon P, Burke LJ, Brennan PF, Karsh BT. Human factors and ergonomics in home care: Current concerns and future considerations for health information technology. Work 2009; 33 (Suppl. 02) 201-209. Epub 2009/08/29. doi: 10.3233/wor-2009-0867. PubMed PMID: 19713630; PubMed Central PMCID: PMCPmc2819983.
  • 18 Or CKL, Karsh B-T. A systematic review of patient acceptance of consumer health information technology. Journal of the American Medical Informatics Association: JAMIA 2009; 16 (Suppl. 04) 550-560. PubMed PMID: 19390112; PubMed Central PMCID: PMCPMC2705259.
  • 19 Holden RJ, Karsh B-T. A review of medical error reporting system design considerations and a proposed cross-level systems research framework. Human Factors: The Journal of the Human Factors and Ergo-nomics Society 2007; 49 (Suppl. 02) 257-276.
  • 20 Carayon P. A longitudinal study of job design and worker strain: Preliminary results.. Quick JC, Murphy LR, Hurrell JJ. (Eds.), editor. Washington, DC: American Psychological Association; 1992
  • 21 Wright A, Phansalkar S, Bloomrosen M, Jenders RA, Bobb AM, Halamka JD, Keuperman G, Payne TH, Teasdale S, Vaida AJ, Bates DW. Best practices in clinical decision support: The case of preventive care reminders. Appl Clin Inform 2010; 1 (Suppl. 03) 331-345.
  • 22 Kales HC, Gitlin LN, Lyketsos CG. Management of neuropsychiatric symptoms of dementia in clinical settings: recommendations from a multidisciplinary expert panel. Journal of the American Geriatrics Society 2014; 62 (Suppl. 04) 762-769.
  • 23 Kales HC, Gitlin LN, Lyketsos CG. State of the Art Review: Assessment and management of behavioral and psychological symptoms of dementia. BMJ: British Medical Journal 2015; 350.
  • 24 Crabtree BF, Miller WL. Doing qualitative research. Sage Publications; 1999
  • 25 Lucero R, Sheehan B, Yen P, Velez O, Nobile-Hernandez D, Tiase V. Identifying consumer’s needs of health information technology through an innovative participatory design approach among English-and Spanish-speaking urban older adults. Applied clinical informatics 2014; 5 (Suppl. 04) 943-957.
  • 26 Mickan S, Tilson JK, Atherton H, Roberts NW, Heneghan C. Evidence of effectiveness of health care professionals using handheld computers: a scoping review of systematic reviews. Journal of medical Internet research 2013; 15 (Suppl. 10) e212.
  • 27 Kreuter MW, Farrell DW, Olevitch LR, Brennan LK. Tailoring health messages: Customizing communication with computer technology. Routledge; 2013
  • 28 Civljak M, Stead LF, Hartmann-Boyce J, Sheikh A, Car J. Internet-based interventions for smoking cessation. Cochrane Database Syst Rev 2013; 7.
  • 29 Strecher VJ, Shiffman S, West R. Randomized controlled trial of a web[uni2010]based computer[uni2010]tailored smoking cessation program as a supplement to nicotine patch therapy. Addiction 2005; 100 (Suppl. 05) 682-688.
  • 30 Hutton HE, Wilson LM, Apelberg BJ, Tang EA, Odelola O, Bass EB, Chander G. A systematic review of randomized controlled trials: Web-based interventions for smoking cessation among adolescents, college students, and adults. Nicotine & Tobacco Research 2011; 13 (Suppl. 04) 227-238.
  • 31 Boots LM, Wolfs CA, Verhey FR, Kempen GI, de Vugt ME. Qualitative study on needs and wishes of early-stage dementia caregivers: the paradox between needing and accepting help. International Psychogeriatrics 2015; 27 (Suppl. 06) 927-936.
  • 32 Washington KT, Meadows SE, Elliott SG, Koopman RJ. Information needs of informal caregivers of older adults with chronic health conditions. Patient Educ Couns 2011; 83 (Suppl. 01) 37-44.
  • 33 Wald C, Fahy M, Walker Z, Livingston G. What to tell dementia caregivers—the rule of threes. Int J Geriatr Psychiatry 2003; 18 (Suppl. 04) 313-317.
  • 34 Camerini L, Camerini A-L, Schulz PJ. Do participation and personalization matter? A model-driven evaluation of an Internet-based patient education intervention for fibromyalgia patients. Patient Educ Couns 2013; 92 (Suppl. 02) 229-234.
  • 35 van Gemert-Pijnen JE, Nijland N, van Limburg M, Ossebaard HC, Kelders SM, Eysenbach G, Seydel ER. A holistic framework to improve the uptake and impact of eHealth technologies. J Med Internet Res 2011; 13 (Suppl. 04) e111.