Davide Bolchini

Permanent URI for this collection

https://hdl.handle.net/1805/6684

Enhancing Web Navigation for Aural Experiences

Dr. Bolchini's research seeks to identify the potential and limits of aural navigation paradigms to enhance the effectiveness of web navigation by performing a series of evaluation studies involving visually-impaired participants using screen readers and sighted participants using mobile devices. The navigation in a website is made possible by web pages which visually communicate virtually instantaneously extensive information, including content, overall semantics, orientation cues, and navigation possibilities. For users who are visually impaired or who cannot look at a screen while performing other tasks (e.g. driving or walking), this multidimensional communication may be difficult or even impossible to access. Existing aural technologies (e.g. screen readers, aural browsers) and web accessibility standards, although powerful and enabling, do not fully address this problem, as they read aloud content rather than conceptually translating a complex communication process. In this context, audio is a strictly linear channel which makes aural navigation in large information architectures a very difficult and frustrating task. Supported by the National Science Foundation, Dr. Bolchini's research explores innovative design strategies for the aural navigation of complex web information architectures, where users exclusively or primarily listen to, rather than look at, content and navigational prompts.

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Naturalistic Decision Making in Everyday Self-care Among Older Adults With Heart Failure
(Wolters Kluwer, 2020-12-23) Daley, Carly N.; Cornet, Victor P.; Toscos, Tammy R.; Bolchini, Davide P.; Mirro, Michael J.; Holden, Richard J.; Regenstrief Institute, School of Medicine
BACKGROUND: Every day, older adults living with heart failure make decisions regarding their health that may ultimately affect their disease trajectory. Experts describe these decisions as instances of naturalistic decision making influenced by the surrounding social and physical environment and involving shifting goals, high stakes, and the involvement of others. OBJECTIVE: This study applied a naturalistic decision-making approach to better understand everyday decision making by older adults with heart failure. METHODS: We present a cross-sectional qualitative field research study using a naturalistic decision-making conceptual model and critical incident technique to study health-related decision making. The study recruited 24 older adults with heart failure and 14 of their accompanying support persons from an ambulatory cardiology center. Critical incident interviews were performed and qualitatively analyzed to understand in depth how individuals made everyday health-related decisions. RESULTS: White, male (66.7%), older adults' decision making accorded with a preliminary conceptual model of naturalistic decision making occurring in phases of monitoring, interpreting, and acting, both independently and in sequence, for various decisions. Analyses also uncovered that there are barriers and strategies affecting the performance of these phases, other actors can play important roles, and health decisions are made in the context of personal priorities, values, and emotions. CONCLUSIONS: Study findings lead to an expanded conceptual model of naturalistic decision making by older adults with heart failure. In turn, the model bears implications for future research and the design of interventions grounded in the realities of everyday decision making.
Untold Stories in User-Centered Design of Mobile Health: Practical Challenges and Strategies Learned From the Design and Evaluation of an App for Older Adults With Heart Failure
(JMIR Publications, 2020-07-21) Cornet, Victor Philip; Toscos, Tammy; Bolchini, Davide; Ghahari, Romisa Rohani; Ahmed, Ryan; Daley, Carly; Mirro, Michael J.; Holden, Richard J.; Medicine, School of Medicine
Background User-centered design (UCD) is a powerful framework for creating useful, easy-to-use, and satisfying mobile health (mHealth) apps. However, the literature seldom reports the practical challenges of implementing UCD, particularly in the field of mHealth. Objective This study aims to characterize the practical challenges encountered and propose strategies when implementing UCD for mHealth. Methods Our multidisciplinary team implemented a UCD process to design and evaluate a mobile app for older adults with heart failure. During and after this process, we documented the challenges the team encountered and the strategies they used or considered using to address those challenges. Results We identified 12 challenges, 3 about UCD as a whole and 9 across the UCD stages of formative research, design, and evaluation. Challenges included the timing of stakeholder involvement, overcoming designers’ assumptions, adapting methods to end users, and managing heterogeneity among stakeholders. To address these challenges, practical recommendations are provided to UCD researchers and practitioners. Conclusions UCD is a gold standard approach that is increasingly adopted for mHealth projects. Although UCD methods are well-described and easily accessible, practical challenges and strategies for implementing them are underreported. To improve the implementation of UCD for mHealth, we must tell and learn from these traditionally untold stories.
Patient-centered Design Grounded in User and Clinical Realities: Towards Valid Digital Health
(Sage, 2019-09) Cornet, Victor P.; Daley, Carly; Bolchini, Davide; Toscos, Tammy; Mirro, Michael J.; Holden, Richard J.; Medicine, School of Medicine
Valid design of patient-centered digital health or health information technology (IT) systems is based on a thorough and accurate understanding of both “user reality” and “clinical reality.” Type 1 Design Error (User-Reality Error) occurs when designers do not accommodate user characteristics, tasks, context of use, needs, or preferences. Type 2 Design Error (Clinical-Reality Error) occurs when designers do not accommodate the clinical reality, including biomedical knowledge, clinical workflows, and organizational requirements. Both types of errors can invalidate the design, leading to products being rejected by patient end-users or their healthcare delivery systems, product non-use or inappropriate use, and risk of harm. This paper describes our attempts to achieve valid health IT design and avoid the two design errors. We performed iterative, patient-centered design to prototype a mobile application, Power to the Patient (P2P), supporting heart failure self-care management. Our multidisciplinary team of human factors, cardiology, and design experts developed and iteratively refined requirements based on data collection, review, and testing with patient research participants, a patient advisory board, a clinical advisory board, and experts on the team. We describe our process and reflect on working with multiple stakeholders toward the goal of valid health IT design.
Uncertainty Management Among Older Adults with Heart Failure: Responses to Receiving Implanted Device Data using a Fictitious Scenario Interview Method
(Sage, 2019) Daley, Carly; Cornet, Victor; Patekar, Gauri; Kosarabe, Swapnil; Bolchini, Davide; Toscos, Tammy; Mirro, Michael; Wagner, Shauna; Martin, Elizabeth; Ghahari, Romisa Rohani; Ahmed, Ryan; Miller, Amy; Holden, Richard J.; Medicine, School of Medicine
Heart failure (HF) is a complex chronic illness that affects the older adult population, requiring medical therapy and day-to-day management to prevent worsening and exacerbation. Patients with HF are often treated with cardiac implanted electronic devices (CIEDs) which capture diagnostic and predictive parameters for HF. In this work we explore how patients would respond to receiving data from an implanted device, using a fictitious scenario interview method with 24 older adults with HF. We applied an uncertainty management lens to better understand how patients face uncertain outcomes and integrate novel data into their decision making. The findings provide insight into how patients would engage and respond to a technology which provides an indicator of their HF status from an implanted device.
Question-Generating Datasets: Facilitating Data Transformation of Official Statistics for Broad Citizenry Decision-Making
(Universitat Politècnica de València, 2020-05) Yadav, Rahul; Herzog, Patricia Snell; Bolchini, Davide; Lilly Family School of Philanthropy
Citizenry decision-making relies on data for informed actions, and official statistics provide many of the relevant data needed for these decisions. However, the wide, distributed, and diverse datasets available from official statistics remain hard to access, scrutinise and manipulate, especially for non-experts. As a result, the complexities involved in official statistical databases create barriers to broader access to these data, often rendering the data non-actionable or irrelevant for the speed at which decisions are made in social and public life. To address this problem, this paper proposes an approach to automatically generating basic, factual questions from an existing dataset of official statistics. The question generating process, now specifically instantiated for geospatial data, starts from a raw dataset and gradually builds toward formulating and presenting users with examples of questions that the dataset can answer, and for which geographic units. This approach exemplifies a novel paradigm of question-first data rendering, where questions, rather than data tables, are used as a human-centred and relevant access points to explore, manipulate, navigate and cross-link data to support decision making. This approach can automate time-consuming aspects of data transformation and facilitate broader access to data.
Simulated Clinical Encounters Using Patient-Operated mHealth: Experimental Study to Investigate Patient-Provider Communication
(JMIR, 2018-11-01) Tunnell, Harry; Faiola, Anthony; Bolchini, Davide; Bartlett Ellis, Rebecca J.; Human-Centered Computing, School of Informatics and Computing
BACKGROUND: This study investigates patient-centered mobile health (mHealth) technology in terms of the secondary user experience (UX). Specifically, it examines how personal mobile technology, under patient control, can be used to improve patient-provider communication about the patient's health care during their first visit to a provider. Common ground, a theory about language use, is used as the theoretical basis to examine interactions. A novel concept of this study is that it is one of the first empirical studies to explore the relative meaningfulness of a secondary UX for specific health care tasks. OBJECTIVE: The objective of this study was to investigate the extent that patient-operated mHealth technology can be designed to improve the communication between the patient and provider during an initial face-to-face encounter. METHODS: The experimental study was conducted in 2 large Midwestern cities from February 2016 to May 2016. A custom-designed smartphone app prototype was used as the study treatment. The experimental design was posttest-only control group and included video-recorded simulated face-to-face clinical encounters in which an actor role-played a patient. Experienced clinicians consisting of doctors (n=4) and nurses (n=8) were the study participants. A thematic analysis of qualitative data was performed. Quantitative data collected from time on task measurements were analyzed using descriptive statistics. RESULTS: Three themes that represent how grounding manifested during the encounter, what it meant for communication during the encounter, and how it influenced the provider's perception of the patient emerged from the qualitative analysis. The descriptive statistics were important for inferring evidence of efficiency and effectiveness of communication for providers. Overall, encounter and task times averaged slightly faster in almost every instance for the treatment group than that in the control group. Common ground clearly was better in the treatment group, indicating that the idea of designing for the secondary UX to improve provider outcomes has merit. CONCLUSIONS: Combining the notions of common ground, human-computer interaction design, and smartphone technology resulted in a prototype that improved the efficiency and effectiveness of face-to-face collaboration for secondary users. The experimental study is one of the first studies to demonstrate that an investment in the secondary UX for high payoff tasks has value but that not all secondary UXs are meaningful for design. This observation is useful for prioritizing how resources should be applied when considering the secondary UX.
Guidelines to Incorporate a Clinician User Experience (UX) into the Design of Patient-Operated mHealth
(ACM, 2017-05) Tunnell, Harry; Faiola, Anthony; Bolchini, Davide; Human-Centered Computing, School of Informatics and Computing
This interactivity demonstration paper highlights how a patient-operated mHealth solution can be designed to improve clinician understanding of a patient's health status during a first face-to-face encounter. Patients can use smartphones to retrieve difficult-to-recall-from memory personal health information. This provides an opportunity to improve patient-clinician collaboration. To explore this idea, a mixed method study with 12 clinicians in a simulated encounter was conducted. A smartphone personal health record was prototyped and used for an experimental study. Communication, efficiency, and effectiveness was improved for clinicians who experienced the prototype. Study outcomes included a validated set of design guidelines for mHealth tools to support better patient-clinician communication.
Endorsement, Prior Action, and Language: Modeling Trusted Advice in Computerized Clinical Alerts
(ACM, 2016-05) Chattopadhyay, Debaleena; Duke, Jon; Bolchini, Davide; Human-Centered Computing, School of Informatics and Computing
The safe prescribing of medications via computerized physician order entry routinely relies on clinical alerts. Alert compliance, however, remains surprisingly low, with up to 95% often ignored. Prior approaches, such as improving presentational factors in alert design, had limited success, mainly due to physicians' lack of trust in computerized advice. While designing trustworthy alert is key, actionable design principles to embody elements of trust in alerts remain little explored. To mitigate this gap, we introduce a model to guide the design of trust-based clinical alerts-based on what physicians value when trusting advice from peers in clinical activities. We discuss three key dimensions to craft trusted alerts: using colleagues' endorsement, foregrounding physicians' prior actions, and adopting a suitable language. We exemplify our approach with emerging alert designs from our ongoing research with physicians and contribute to the current debate on how to design effective alerts to improve patient safety.
Semi-aural Interfaces: Investigating Voice-controlled Aural Flows
(Oxford, 2016-11) Ghahari, Romisa Rohani; George-Palilonis, Jennifer; Gahangir, Hossain; Kaser, Lindsay; Bolchini, Davide; Department of Human-Centered Computing, School of Informatics and Computing
To support mobile, eyes-free web browsing, users can listen to ‘playlists’ of web content— aural flows . Interacting with aural flows, however, requires users to select interface buttons, tethering visual attention to the mobile device even when it is unsafe (e.g. while walking). This research extends the interaction with aural flows through simulated voice commands as a way to reduce visual interaction. This paper presents the findings of a study with 20 participants who browsed aural flows either through a visual interface only or by augmenting it with voice commands. Results suggest that using voice commands reduced the time spent looking at the device by half but yielded similar system usability and cognitive effort ratings as using buttons. Overall, the low-cognitive effort engendered by aural flows, regardless of the interaction modality, allowed participants to do more non-instructed (e.g. looking at the surrounding environment) than instructed activities (e.g. focusing on the user interface).
Understanding Advice Sharing among Physicians: Towards Trust-Based Clinical Alerts
(Oxford, 2016-06) Chattopadhyay, Debaleena; Ghahari, Romisa Rohani; Duke, Jon; Bolchini, Davide; Department of Human-Centered Computing, School of Informatics and Computing
Safe prescribing of medications relies on drug safety alerts, but up to 96% of such warnings are ignored by physicians. Prior research has proposed improvements to the design of alerts, but with limited increase in adherence. We propose a different perspective: before re-designing alerts, we focus on improving the trust between physicians and computerized advice by examining why physicians trust their medical colleagues. To understand trusted advice among physicians, we conducted three contextual inquiries in a hospital setting (22 participants), and corroborated our findings with a survey (37 participants). Drivers that guide physicians in trusting peer advice include: timeliness of the advice, collaborative language, empathy, level of specialization and medical hierarchy. Based on these findings, we introduce seven design directions for trust-based alerts: endorsement, transparency, team sensing, collaborative, empathic, conflict mitigating and agency laden. Our work contributes to novel alert design strategies to improve the effectiveness of drug safety advice.

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