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Retriage is the emergent interhospital transfer of severely injured patients from nontrauma and low-level trauma centers to high-level trauma centers. An estimated 17%-34% of patients with traumatic injury are undertriaged to nontrauma or low-level trauma centers in the United States each year. These patients see 30% increased odds of mortality at 48 hours and nearly 4-fold increased odds of overall mortality. However, 30%-50% of undertriaged patients are never retriaged to a high-level trauma center. Informatics-driven solutions facilitate time-sensitive exchange of patient information in other health care contexts. Few studies have explored how informatics-driven solutions can be tailored to address obstacles to timely, effective retriage. We applied user-centered design to develop a robust, acceptable, and feasible digital health solution to improve the retriage process. This was a mixed methods, observational, cross-sectional study. Potential frontline users of an intervention and hospital leadership were recruited to participate. Individuals in these roles included trauma medical directors, emergency department directors, trauma surgeons, emergency medicine physicians, emergency department nurse managers, emergency department nurses, trauma coordinators, emergency department bed managers, and health unit coordinators at nontrauma or low-level trauma centers and high-level trauma centers. We applied the 5-phase user-centered design approach, including phase 1: understanding the design needs, through site visit observations and focus groups; phase 2: ideation of potential solutions through a second round of virtual focus groups; phase 3: rank ordering solutions to identify the most robust, acceptable, and potentially feasible solutions; phase 4: prototyping by creating low-fidelity prototypes for the highest-ranked solutions; and phase 5: validation of the robustness of the prototypes through virtual focus groups. Validation approaches included asking frontline end users to assess the feasibility of each prototype and whether prototypes would address the identified retriage failures and barriers. In addition, leaders were asked to assess the feasibility of implementing the proposed solutions in their trauma center. All virtual sessions were recorded, transcribed, and inductively coded to generate themes of robustness, acceptability, and feasibility of the retriage solution. Thematic analysis was anchored on the desirability, viability, and feasibility design thinking methodology. Nineteen sessions were conducted across all 5 phases with 49 participants from 12 trauma centers across Illinois. Participants included frontline users and leadership. The key design requirement was resource transparency between centers. The ideation phase produced 70 solutions. A systemwide bed tracker was ranked the highest by participants. Prototyping and validation resulted in a centralized, systemwide, bed tracker with hourly updated bed availability being the final solution to improve the retriage of patients with traumatic injury from non- or low-level trauma centers and high-level trauma centers. A 5-phase user-centered design approach resulted in a single solution consisting of a digital bed-tracker with frequently updated data on beds at high-level trauma centers to improve retriage.

Dementia is a widespread syndrome that currently affects more than 55 million people worldwide. Digital screening instruments are one way to increase diagnosis rates. Developing an app for older adults presents several challenges, both technical and social. In order to make the app user-friendly, feedback from potential future end users is crucial during this development process. This study aimed to establish a user-centered design process for the development of digiDEM-SCREEN, a user-friendly app to support early identification of persons with slight symptoms of dementia. This research used qualitative and quantitative methods and involved 3 key stakeholder groups: the digiDEM research team, the software development team, and the target user group (older adults ≥65 years with and without cognitive impairments). The development of the screening app was based on an already existing and scientifically analyzed screening test (Self-Administered Tasks Uncovering Risk of Neurodegeneration; SATURN). An initial prototype was developed based on the recommendations for mobile health apps and the teams' experiences. The prototype was tested in several iterations by various end users and continuously improved. The app's usability was evaluated using the System Usability Scale (SUS), and verbal feedback by the end users was obtained using the think-aloud method. The translation process during test development took linguistic and cultural aspects into account. The texts were also adapted to the German-speaking context. Additional instructions were developed and supplemented. The test was administered using different randomization options to minimize learning effects. digiDEM-SCREEN was developed as a tablet and smartphone app. In the first focus group discussion, the developers identified and corrected the most significant criticism in the next version. Based on the iterative improvement process, only minor issues needed to be addressed after the final focus group discussion. The SUS score increased with each version (score of 72.5 for V1 vs 82.4 for V2), while the verbal feedback from end users also improved. The development of digiDEM-SCREEN serves as an excellent example of the importance of involving experts and potential end users in the design and development process of health apps. Close collaboration with end users leads to products that not only meet current standards but also address the actual needs and expectations of users. This is also a crucial step toward promoting broader adoption of such digital tools. This research highlights the significance of a user-centered design approach, allowing content, text, and design to be optimally tailored to the needs of the target audience. From these findings, it can be concluded that future projects in the field of health apps would also benefit from a similar approach.

Maternal mental health disorders are prevalent, yet many individuals do not receive adequate support due to stigma, financial constraints, and limited access to care. Digital interventions, particularly chatbots, have the potential to provide scalable, low-cost support, but few are tailored specifically to the needs of perinatal individuals. This study aimed to (1) design and develop Moment for Parents, a tailored chatbot for perinatal mental health education and support, and (2) assess usability through engagement, usage patterns, and user experience. This study used a human-centered design to develop Moment for Parents, a rules-based chatbot to support pregnant and postpartum individuals. In phase 1, ethnographic interviews (n=43) explored user needs to inform chatbot development. In phase 2, a total of 108 pregnant and postpartum individuals were recruited to participate in a pilot test and had unrestricted access to the chatbot. Engagement was tracked over 8 months to assess usage patterns and re-engagement rates. After 1 month, participants completed a usability, relevance, and satisfaction survey, providing key insights for refining the chatbot. Key themes that came from the ethnographic interviews in phase 1 included the need for trusted resources, emotional support, and better mental health guidance. These insights informed chatbot content, including mood-based exercises and coping strategies. Re-engagement was high (69/108, 63.9%), meaning users who had stopped interacting for at least 1 week returned to the chatbot at least once. A large proportion (28/69, 40.6%) re-engaged 3 or more times. Overall, 28/30 (93.3%) found the chatbot relevant for them, though some noted repetitive content and limited response options. The Moment for Parents chatbot successfully engaged pregnant and postpartum individuals with higher-than-typical retention and re-engagement patterns. The findings underscore the importance of flexible, mood-based digital support tailored to perinatal needs. Future research should examine how intermittent chatbot use influences mental health outcomes and refine content delivery to enhance long-term engagement and effectiveness.

With the rapid expansion of artificial intelligence (AI) applications, researchers have begun focusing on the concept of human-centered artificial intelligence (HCAI). This field is dedicated to designing AI systems that augment and improve human abilities, rather than substituting them. The objective of the paper was to review the information on design principles, techniques, applications, methods, and outcomes adopted in the field of HCAI, in order to provide some insights on the discipline, in relation with the broader concepts of human-centered and user-centered design. Following the Preferred Reporting Items for Systematic Reviews and Meta-Analyses Extension for Scoping Reviews (PRISMA-ScR) checklist guidelines, we conducted a scoping review in PubMed, ScienceDirect, and IEEE Xplore, including all study types, excluding narrative reviews and editorials. Out of the 1035 studies retrieved, 14 studies conducted between 2018 and 2023 met the inclusion criteria. The main fields of application were the health sector and AI applications. Human-centered design methodologies were adopted in 3 studies, personas in 2 studies, while the remaining methodologies were adopted in individual studies. HCAI emphasizes designing AI systems that prioritize human needs, satisfaction, and trustworthiness, but current principles and guidelines are often vague and difficult to implement. The review highlights the importance of involving users early in the development process to enhance trust, especially in fields like health care, but notes that there is a lack of standardized HCAI methodologies and limited practical applications adhering to these principles.

Problem anger is common after experiencing trauma and is under-recognized relative to other posttraumatic mental health issues. Previous research has shown that digital mental health tools have significant potential to support individuals with problem anger after trauma. The objective of this study was to describe the co-design and development of a just-in-time adaptive intervention (JITAI) targeting problem anger in individuals who have experienced trauma. We used a participatory design process following the double-diamond framework. Phase 1 involved one-on-one qualitative interviews with trauma-exposed individuals with problem anger (n=10). Using an inductive approach (interpretative phenomenological analysis), we thematically coded interview data to create design principles for this population and generate potential content for the intervention. Phase 2 involved academic and clinical experts in trauma and experts in digital health reviewing the Phase 1 results and an evidence-based cognitive behavioral approach to treating anger. We then created intervention content and prototypes, which we then took to workshops with all participants for feedback, using group discussions and ratings of desirability and feasibility. From Phase 1, core considerations for a JITAI included look and feel preferences, self-led and personalized support and content, and different support needed for each anger stage. A JITAI was developed with the following components: (1) personalized schedules and content onboarding; (2) psychoeducation about problem anger; (3) crisis support; (4) mood monitoring via anger check-ins; (5) self-led and personalized circuit breakers; (6) cognitive-behavioral based skills; (7) and a digital Coach embedded in the app. Some suggested features, such as social networking and sharing data with loved ones, were not pursued due to feasibility reasons relating to participant safety or technical costs. The resulting JITAI, termed \"Shift,\" is the first digital mental health tool designed with end users to manage anger after trauma.

While patient and public involvement and engagement (PPIE) is now seen as a cornerstone of mental health research, young people's involvement in PPIE faces limitations. Work and school demands and more limited independence can make it challenging for young people to engage with PPIE. Lack of ability or desire to attend face-to-face meetings or group discussions can further compound this difficulty. The VoiceIn app and digital platform were codeveloped by a multidisciplinary team of young people, mental health researchers, and software designers, and enables young people to engage directly with PPIE opportunities via a mobile app. This paper aims to describe how VoiceIn was developed through a series of co-design workshops with relevant stakeholders, specifically (1) how the initial design of VoiceIn was informed and driven by focus groups with young people, mental health professionals, and PPIE leads; (2) how VoiceIn was refined through collaboration with the aforementioned stakeholders; (3) the priorities for an app to support PPIE; (4) the key features necessary in the PPIE app; and (5) the recommended next steps in testing and deploying the digital platform. Initial co-design workshops took place with young people, mental health professionals, and PPIE leads to identify key features of an app to support PPIE. A series of VoiceIn design prototypes were developed and iterated based on the priorities and preferences of the stakeholders. The MoSCoW (must have, should have, could have, won't have) prioritization method was used throughout the process to identify priorities across the different stakeholder groups. Co-design with young people, mental health professionals, and PPIE leads supported the successful development and improvement of the VoiceIn app. As a result of this process, key features were identified, including allowing for various modes of providing feedback (eg, polls and comments), reviewing project updates, and expressing interest in categories of research. The researcher platform was developed to support multimedia uploads for project descriptions; a jargon detector; a dedicated section for providing project updates; and a visually appealing, user-friendly design. While all stakeholder groups emphasized the importance of allowing app users to engage with the app in various ways and for there to be ongoing progress updates, group differences were also noticed. Young people expressed a desire for incentives and rewards for engaging with the app (eg, to post on their public social media profiles), and mental health professionals and PPIE leads prioritized flexibility in describing the project and its PPIE needs. A co-design approach was pivotal to the development of the VoiceIn app. This collaborative approach enabled the app to meet the divergent needs of young people, mental health professionals, and PPIE leads. This process mirrored the aspirations of PPIE initiatives by cocreating a digital health research tool with key stakeholders.

Technology is more likely to be used when it is designed to meet the needs of end users. To supplement the Small Steps for Big Changes diabetes prevention program, a smartphone app was developed in partnership with past Small Steps for Big Changes clientele. Usability testing is critical for the ongoing use and adoption of mobile health apps by providing insight on where appropriate adjustments and improvements need to be made to ensure user satisfaction. A focus group with 7 participants was conducted to examine the app's usability and collect feedback for future iterations. Past Small Steps for Big Changes clientele participated in a cognitive walkthrough of 8 novel tasks and completed the System Usability Scale survey. Participants were then given the option to use the app for 3 weeks before completing the User-Mobile Application Rating Scale. Analysis of the cognitive walkthrough identified 26 usability problems; each was coded using a heuristic evaluation to describe usability errors. The most frequently coded errors included inappropriate progress feedback, information appearing in an illogical order, counterintuitive design, and issues with app aesthetics. A mean summary score of 66.8% (SD 18.91) was reported for the System Usability Scale, representing a marginal acceptability score and indicating that design issues needed to be resolved. A User-Mobile Application Rating Scale mean score of 3.59 (SD 0.33) was reported, implying an average acceptability rating. These findings identified necessary improvements in the app, ranging from minor aesthetic problems to major functionality problems. Involving end users allows the app to be tailored to the client's preferences and increases the likelihood of usage. This app aligns with Small Steps for Big Changes' program components and behavior change techniques that can improve health outcomes for future clients and allow them to self-monitor their exercise, diet, and goals.

The increasing prevalence of mental health disorders among youth underscores the need for accessible and effective interventions. Digital mental health (dMH) platforms like Innowell offer promising solutions by increasing access to mental health care for young people. Innowell is a web-based platform that supports youth mental health by providing personalized measurement-based care in collaboration with a youth's health care providers. However, understanding youth perspectives on these platforms is crucial for ensuring successful implementation and sustained engagement. This study aimed to explore youth perspectives on the implementation of the Innowell platform, identifying key factors influencing uptake, engagement, and long-term retention. A qualitative descriptive approach was used to examine youth perspectives. Data were collected through 9 focus groups and 1 interview, involving 39 participants aged 15-24 years from urban (23/39, 59%) and rural (16/39, 41%) communities in Alberta, Canada. Participants were recruited through mental health clinics and community organizations. Thematic analysis was conducted on the transcripts to identify factors that support or hinder engagement with the platform. Participants emphasized the importance of privacy, security, and personalization in building trust in the platform, with 72% (28/39) reporting that clear communication about data protection would increase their likelihood of use. Progress tracking features, such as symptom trend visualizations and diaries, were identified by 65% (25/39) of participants as critical for sustaining engagement. Ease of use was highlighted, with 58% (23/39) preferring mobile app functionality over web-based interfaces. Dynamic content and personalized notifications were suggested as strategies to maintain long-term use, with 64% (25/39) of participants valuing customizable reminders to encourage daily interactions. Rural participants (16/39, 41%) noted the need for offline functionality due to inconsistent internet access. In addition, participants recommended features such as crisis support, professional communication channels, and access to local mental health resources. Youth-centered design is essential for enhancing the usability and engagement of dMH platforms like Innowell. Key features prioritized by participants included privacy, security, progress tracking, and personalization. Dynamic and user-friendly interfaces, along with the ability to customize notifications and access professional support, were critical for fostering long-term engagement. Insights from this study provide actionable recommendations for optimizing dMH platforms to meet the mental health needs of young people, particularly in diverse urban and rural settings. Future research should explore implementation strategies tailored to specific user demographics to enhance the scalability and impact of dMH interventions.

Only 15% of the nearly 30 million Americans with hearing loss use hearing aids, partly due to high cost, stigma, and limited access to professional hearing care. Hearing impairment in adults can lead to social isolation and depression and is associated with an increased risk of falls. Given the persistent barriers to hearing aid use, the Food and Drug Administration issued a final rule to allow over-the-counter hearing aids to be sold directly to adult consumers with perceived mild to moderate hearing loss at pharmacies, stores, and online retailers without seeing a physician or licensed hearing health care professional. We evaluated the safety and usability of an over-the-counter hearing aid prior to Food and Drug Administration approval and market release. We first conducted a formative usability test of the device and associated app with 5 intended users to identify outstanding safety and usability issues (testing round 1). Following design modifications, we performed a summative usability test with 15 intended users of the device (testing round 2). We concurrently conducted a test with 21 nonintended users (ie, users with contraindications to use) to ascertain if consumers could determine when they should not use the device, based on the packaging, instructions, and labeling (testing round 3). Participants were asked to complete 2-5 tasks, as if they were using the hearing aid in real life. After each task, participants rated the task difficulty. At the end of each session, participants completed a 10-question knowledge assessment and the System Usability Scale and then participated in debriefing interviews to gather qualitative feedback. All sessions were video recorded and analyzed to identify use errors and design improvement opportunities. Usability issues were identified in all 3 usability testing rounds. There were minimal safety-related issues with the device. Round 1 testing led to several design modifications which then increased task success in round 2 testing. Participants had the most difficulty with the task of pairing the hearing aids to the cell phone. Participants also had difficulty distinguishing the right and left earbuds. Nonintended users did not always understand device contraindications (eg, tinnitus and severe hearing loss). Overall, test findings informed 9 actionable design modifications (eg, clarifying pairing steps and increasing font size) that improved device usability and safety. This study evaluated the usability and safety of an over-the-counter hearing aid for adults with mild to moderate hearing loss. Human factors engineering methods identified opportunities to improve the safety and usability of this direct-to-consumer medical device for individuals with perceived mild-moderate hearing loss.

Traumatic brain injury (TBI) is a significant public health issue and a leading cause of death and disability globally. Advances in clinical care have improved survival rates, leading to a growing population living with long-term effects of TBI, which can impact physical, cognitive, and emotional health. These effects often require continuous management and individualized care. Traditional paper-based assessments can be cumbersome, potentially impeding regular monitoring of patient-reported outcomes (PROs). Electronic PROs (ePROs) offer a promising alternative by enabling real-time symptom tracking, which can facilitate early identification of issues, support shared decision-making, and improve outcomes for patients with TBI. This study evaluates the usability of an ePRO platform-Atom5-for individuals with TBI. By analyzing how patients use the system to report their symptoms, the study aims to identify usability issues, assess user satisfaction, and determine the potential of Atom5 to support ongoing patient-centered care. Atom5 was customized to enable individuals with TBI to report their symptoms. Usability testing was conducted through one-on-one sessions with participants recruited from Headway UK-an organization supporting brain injury survivors. Each participant took part in cognitive interviews using with the \"Think Aloud\" method, encouraging them to verbalize their thoughts and experiences while using the platform. This approach provided qualitative insights into areas of difficulty, usability strengths, and accessibility barriers. User satisfaction was quantitatively assessed with a brief 4-item questionnaire based on the System Usability Scale. Usability outcomes were analyzed for critical and noncritical errors, focusing on user experience and overall satisfaction. In total, 9 participants completed a single usability testing session using Atom5, including 4 men, 4 women, and 1 nonbinary individual; 4 participants were under 55 years old, and 6 had their TBI <10 years ago. Finally, 8 participants used an Android device. The platform included measures for anxiety (Generalized Anxiety Disorder-2 item), depression (Patient Health Questionnaire-2), posttraumatic stress disorder (Posttraumatic Stress Disorder checklist 2), and TBI-specific quality of life (Traumatic Brain Injury - Quality of Life Short form) and a total of 26 questions. Overall, all participants were satisfied with the system, noting that it was easy to navigate and accessible despite difficulties in understanding some questions. Further, 6 participants encountered no errors, while 1 participant reported one critical error and 2 others reported one noncritical error each. The participants rated their overall satisfaction with the platform at an average score of 3.9 (SD 0.49) out of 5. This usability study suggests that individuals living with TBI can effectively report symptoms using the Atom5 ePRO platform, with generally high satisfaction and few usability issues, thereby enabling continuous monitoring and proactive symptom management. Future ePRO development should focus on inclusivity and adaptability to address the diverse needs of patients with TBI, ensuring these tools can effectively support a wide range of users.