Mobile health IT: the effect of user interface and form factor on doctor-patient communication

Background

Introducing computers into primary care can have negative effects on the doctor-patient dialogue. Little is known about such effects of mobile health IT in point-of-care situations.

Aim

To assess how different mobile information devices used by physicians in point-of-care situations support or hinder aspects of doctor-patient communication, such as face-to-face dialogue, nonverbal communication, and action transparency.

Method

The study draws on two different experimental simulation studies where 22 doctors, in 80 simulated ward rounds, accessed patient-related information from a paper chart, a PDA, and a laptop mounted on a trolley. Video recordings from the simulations were analyzed qualitatively. Interviews with clinicians and patients were used to triangulate the findings and to verify the realism and results of the simulations.

Result

The paper chart afforded smooth re-establishment of eye contact, better verbal and non-verbal contact, more gesturing, good visibility of actions, and quick information retrieval. The digital information devices lacked many of these affordances; physicians’ actions were not visible for the patients, the user interfaces required much attention, gesturing was harder, and re-establishment of eye contact took more time. Physicians used the devices to display their actions to the patients. The analysis revealed that the findings were related to the user interface and form factor of the information devices, as well as the personal characteristics of the physician.

Conclusion

When information is needed and has to be located at the point-of-care, the user interface and the physical form factor of the mobile information device are influential elements for successful collaboration between doctors and patients. Both elements need to be carefully designed so that physicians can use the devices to support face-to-face dialogue, nonverbal communication, and action visibility. The ability to facilitate and support the doctor-patient collaboration is a noteworthy usability factor in the design of mobile EPR systems. The paper also presents possible design guidelines for mobile point-of-care systems for improved doctor-patient communication.     

Understanding mirror neurons: Evidence for enhanced corticospinal excitability during the observation of transitive but not intransitive hand gestures

Putative measures of mirror neuron activity suggest that mirror neurons respond preferentially to biological motion, but it remains unclear whether enhanced cortical activity occurs during the observation of any behaviour, or whether that behaviour needs to be associated with a particular object or goal. Forty-three healthy adults completed a transcranial magnetic stimulation (TMS) experiment that assessed corticospinal excitability while viewing intransitive and transitive hand gestures (compared with the presentation of a static hand). Visual presentations were designed to control for motoric and stimulus properties. A significant increase in corticospinal excitability (putatively reflecting mirror neuron activation) was seen only during the observation of transitive behaviour. These findings are consistent with the notion that human hand-related mirror neurons are sensitive to object- and goal-directed behaviour, rather than biological motion per se.     

Multi-Scale Contingencies During Individual and Joint Action

The present paper describes a joint action paradigm in which individuals or pairs utilized two computer keys to keep a dot stimulus moving inside a larger rectangle. Members of a pair could neither see nor hear each other. This paradigm allowed us to combine the discrete-trial type dependent variables (e.g., reaction time) commonly utilized by representational theorists, with the continuous, temporal dependence variables (e.g., RQA) utilized by dynamical theorists. Analysis revealed that individuals kept the dot in the rectangle longer than dyads and did so by moving it back and forth within the rectangle. Dyads, however, pressed their individual buttons as quickly as possible in order to keep the dot near the middle of the rectangle. These findings indicate that joint action constitutes a multi-scale phenomena that is best investigated via multiple, complementary methodologies versus single-measure, competing theories.     

Perception of affordances for standing on an inclined surface depends on height of center of mass

We investigated whether perception of affordances for standing on an inclined surface depended on the height of center of mass of the perceiver-actor. Participants adjusted the angle of inclination of a surface until they felt that it was just barely possible for them to stand on that surface. They performed this task while wearing a backpack apparatus to which masses were attached in one of three configurations—high-mass, low-mass, and no-mass. Moreover, participants performed this task by viewing the inclined surface or by probing it with a hand-held rod (while blindfolded). Perception of affordances for standing on the inclined surface reflected the changes in center of mass brought on by the weighted backpack apparatus (the perceptual boundary occurred at a smaller angle of inclination in the high-mass condition than in the low-mass condition and in the no-mass condition). Moreover, perception of this affordance reflected such changes both when the surface was viewed and when the surface was probed with a hand-held rod (while blindfolded). The results highlight that perception of affordances is dynamic and task-dependent and suggest that the stimulation patterns that support perception of affordances are invariant and modality-independent.

The macaque lateral grasping network: A neural substrate for generating purposeful hand actions

In primates, neural mechanisms for controlling skilled hand actions primarily rely on sensorimotor transformations. These transformations are mediated by circuits linking specific inferior parietal with ventral premotor areas in which sensory coding of objects’ features automatically triggers appropriate hand motor programs. Recently, connectional studies in macaques showed that these parietal and premotor areas are nodes of a large-scale cortical network, designated as “lateral grasping network,” including specific temporal and prefrontal sectors involved in object recognition and executive functions, respectively. These data extend grasping models so far proposed in providing a possible substrate for interfacing perceptual, cognitive, and hand-related sensorimotor processes for controlling hand actions based on object identity, goals, and memory-based or contextual information and for the contribution of motor signals to cognitive motor functions. Human studies provided evidence for a possible counterpart of the macaque lateral grasping network, suggesting that in primate evolution the neural mechanisms for controlling hand actions described in the macaque have been retained and exploited for the emergence of human-specific motor and cognitive motor capacities.     

Object affordance and spatial-compatibility effects in Parkinson's disease

Movement in Parkinson's disease (PD) is strongly influenced by sensory stimuli. Here, we investigated two features of visual stimuli known to affect response times in healthy individuals; the spatial location of an object (the spatial effect) and its action-relevance (the ‘affordance’ effect). Poliakoff et al. (2007) found that while PD patients show normal spatial effects, they do not show an additional affordance effect. Here we investigated whether these effects are driven by facilitation or inhibition, and whether the affordance effect emerges over a longer time-course in PD. Participants (24 PD and 24 controls) viewed either a lateralised door handle (affordance condition), a lateralised abstract stimulus (spatial condition), or a centrally presented baseline stimulus (baseline condition), and responded to a colour change in the stimulus occurring after 0 msec, 500 msec or 1000 msec. The colour change indicated whether to respond with the left or right hand, which were either spatially compatible or incompatible with the lateralised stimulus orientation in the affordance and spatial conditions. The baseline condition allowed us to assess whether compatibility effects were driven by facilitation of the compatible response or inhibition of the incompatible response. The results indicate that stimulus orientation elicited faster responses from the nearest hand. For controls, the affordance effect was stronger and driven by facilitation, whilst the spatial condition was driven by inhibition. In contrast, the affordance and spatial-compatibility effects did not differ between conditions in the PD group and both were driven by facilitation. This suggests that the PD group responded as if all stimuli were action-relevant, and may have implications for understanding the cueing of movement in PD.     

Affordance processing in segregated parieto-frontal dorsal stream sub-pathways

The concept of affordances indicates “action possibilities” as characterized by object properties the environment provides to interacting organisms. Affordances relate to both perception and action and refer to sensory-motor processes emerging from goal-directed object interaction. In contrast to stable properties, affordances may vary with environmental context. A sub-classification into stable and variable affordances was proposed in the framework of the ROSSI project (Borghi et al., 2010; Borghi and Riggio, 2015, 2009). Here, we present a coordinate-based meta-analysis of functional imaging studies on object interaction targeting consistent anatomical correlates of these different types of affordances. Our review revealed the existence of two parallel (but to some extent overlapping) functional pathways. The network for stable affordances consists of predominantly left inferior parietal and frontal cortices in the ventro-dorsal stream, whereas the network for variable affordances is localized preferentially in the dorso-dorsal stream. This is in line with the proposal of differentiated affordances: stable affordances are characterized by the knowledge of invariant object features, whereas variable affordances underlie adaptation to changing object properties.     

Health outcomes and related effects of using social media in chronic disease management: A literature review and analysis of affordances

Whilst the future for social media in chronic disease management appears to be optimistic, there is limited concrete evidence indicating whether and how social media use significantly improves patient outcomes. This review examines the health outcomes and related effects of using social media, while also exploring the unique affordances underpinning these effects. Few studies have investigated social media’s potential in chronic disease, but those we found indicate impact on health status and other effects are positive, with none indicating adverse events. Benefits have been reported for psychosocial management via the ability to foster support and share information; however, there is less evidence of benefits for physical condition management. We found that studies covered a very limited range of social media platforms and that there is an ongoing propensity towards reporting investigations of earlier social platforms, such as online support groups (OSG), discussion forums and message boards. Finally, it is hypothesized that for social media to form a more meaningful part of effective chronic disease management, interventions need to be tailored to the individualized needs of sufferers. The particular affordances of social media that appear salient in this regard from analysis of the literature include: identity, flexibility, structure, narration and adaptation. This review suggests further research of high methodological quality is required to investigate the affordances of social media and how these can best serve chronic disease sufferers. Evidence-based practice (EBP) using social media may then be considered.     

From pantomime to actual use: how affordances can facilitate actual tool-use

The main goal of the study was to investigate whether the presence of affordances, such as physical properties of given objects and resulting movement constraints, induce a performance increase in actual tool-use compared to demonstrating it with only the tool or pantomiming it without the tool and recipient object. In the present study the perception of affordances was manipulated by omission or supply of contextual information. The three execution modes - pantomiming, demonstration and actual use, - were investigated concerning the actions hammering and scooping in 25 patients with left unilateral brain damage and 10 healthy controls. The content of the movement, the grip formation, the direction and the location of the movement were evaluated with video-analysis. The results show that the pantomime condition is most prone to errors. The information given by the tool and the recipient object in the actual use task seems to facilitate especially scooping - the more complex tool-use action. A factor analysis and the high correlation between performance-scores show that the three execution modes of both actions have a major common factor. One possible joint commonality of the execution modes could be the nature of an action related working memory component, which is responsible for the recall and the integration of semantic information into a movement-plan. Additional analyses with a smaller group revealed a second factor, that might depict the online processing of spatial relationships of the hand, the tool and the recipient objects.The results indicate that performance improvement can be achieved by providing perceptual cues and reducing the degrees of freedom for the required action. It is concluded that manipulating affordances in a tool use context should be taken into consideration for future investigation of therapeutic approaches.     

Grasping the meaning of words

Action affordances can be activated by non-target objects in the visual field as well as by word labels attached to target objects. These activations have been manifested in interference effects of distractors and words on actions. We examined whether affordances could be activated implicitly by words representing graspable objects that were either large (e.g., APPLE) or small (e.g., GRAPE) relative to the target. Subjects first read a word and then grasped a wooden block. Interference effects of the words arose in the early portions of the grasping movements. Specifically, early in the movement, reading a word representing a large object led to a larger grip aperture than reading a word representing a small object. This difference diminished as the hand approached the target, suggesting on-line correction of the semantic effect. The semantic effect and its on-line correction are discussed in the context of ecological theories of visual perception, the distinction between movement planning and control, and the proximity of language and motor planning systems in the human brain.