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Research Summary: How can strategic decision makers overcome inertia when dealing with change? In this article we argue that cognitive flexibility (i.e., the ability to match the type of cognitive processing with the type of problem at hand) enables decision makers to achieve significantly higher decision-making performance. We show that superior decision-making performance is associated with using semiautomatic Type 1 cognitive processes when faced with well-structured problems, and more deliberative Type 2 processes when faced with illstructured problems. Our findings shed light on the individual-level mechanism behind organizational adaptation and complement recent work on strategic inertia. In addition, our findings extend management studies that have stressed the relevance of cognitive flexibility for responding to the demands of increasingly open, flexible, and rapidly changing organizations. Managerial Summary: Humans are creatures of habits. We tend to prefer known courses of action over new ones. In many cases, habits are good. However, when things change in unpredictable ways, the past may not be good guidance for the future. We argue that \"cognitive flexibility\"—the ability of understanding when to rely on habits vs. when to explore new courses of action—enables managers to switch from a \"fast\" decision mode, based on habits, to a \"slow,\" more deliberate decision mode that facilitates the exploration of new courses of action. Managers high in cognitive flexibility reflect on the situation at hand, recognize and value diversity in viewpoints, and integrate such diversity in their own decision processes. By valuing diversity, they are more likely to overcome inertia.

Introduction Diabetic foot ulcers (DFUs) affect approximately one‐quarter of people living with diabetes. They are chronic, recur frequently and are associated with significant psychological distress and behavioural challenges. The REDUCE intervention is a person‐centred, cognitive behavioural intervention designed to reduce the risk of DFU recurrence and support ulcer healing. Here, we describe the iterative development and optimisation of REDUCE, from its inception as a group‐based intervention to an individually tailored intervention delivered via video call or telephone. We outline key stages of the intervention development, including the integration and modification of a digital maintenance intervention (DMI) designed to support long‐term behaviour change and a mixed‐methods external pilot trial which informed a full‐scale clinical and cost‐effectiveness trial. Methods After initial development, the DMI was the subject of nine ‘think‐aloud’ interviews with patient and public contributors. We conducted an external pilot randomised controlled trial, involving 20 patients with recently healed DFUs randomised in a 2:1 ratio (REDUCE + Usual Care vs. Usual Care only). Data collection included patient‐reported outcome measures (baseline and 6 weeks and 3 months post‐randomisation) and qualitative interviews with participants and facilitators. Results Think‐aloud interviews informed key refinements to the DMI to enhance usability and engagement. The pilot trial demonstrated high acceptability of the intervention format and delivery. Patient‐reported outcomes suggested positive trends in psychological well‐being, footcare behaviours and mood among intervention participants. Qualitative findings highlighted the value of individualised delivery, the importance of facilitator support and varied engagement with the DMI. These insights informed further refinements to REDUCE ahead of a full‐scale effectiveness trial. Conclusion We provide a comprehensive account of the evolution of the REDUCE intervention and share broader learnings regarding the development of complex behavioural health interventions. The example of REDUCE highlights the value of iterative, multidisciplinary methods and patient involvement in intervention design and offers practical insights for designing digital and remote health interventions. Patient or Public Contribution Patient and public contributors were involved throughout the research described in this manuscript. Key areas of involvement included co‐creation of all patient‐facing materials, intervention development and informing trial methods.

Background and Aims The Karafs application, a popular mobile health tool in Iran with nearly 5 million users, supports personalized diet plans, healthy cooking, and sports training. This study aimed to evaluate the usability of the Karafs application using the think‐aloud method to identify user interaction challenges and enhance its effectiveness. Methods Fifteen participants (2 men, 13 women; mean age 22 years) evaluated the Karafs application using the think‐aloud method. Usability problems were identified, categorized, and assessed for severity. The evaluation process was analyzed, with an average duration of 10.58 ± 3.46 min. Results Multiple usability issues were identified, primarily related to unclear system messages and navigation challenges. The severity of problems was classified, with most being minor but impacting user efficiency. Conclusion The think‐aloud method effectively identified usability issues in the Karafs application, providing insights for improving user experience. Addressing these issues can enhance the application's functionality and support healthier lifestyle choices.

Mobile health technologies have the potential to enhance the management, communication, and overall quality of life of patients with cancer. The MyPal project, using a participatory design approach, aims to provide palliative care support for patients with cancer through an electronic patient-reported outcomes eHealth platform. This study aims to evaluate the usability and user experience of \"MyPal for adults,\" a co-designed palliative care mobile app designed to support adults with cancer. Representative users participated in a 4-step usability study using a \"think-aloud\" protocol, complemented with feature satisfaction, difficulty perceived, and design impression surveys along with a short, structured interview. Participants were also asked to provide quantitative feedback via the postuse System Usability Scale, User Experience Questionnaire, and Post-Study System Usability Questionnaire. The data were analyzed along the lines of the International Organization for Standardization (ISO) 9241-210 framework. All participants found the intervention content useful, and they reported satisfactory usability, with a mean Post-Study System Usability Questionnaire score of 2.458 (SD 1.08) and a System Usability Scale score of 68.9. All aspects of the User Experience Questionnaire (attractiveness, perspicuity, efficiency, dependability, stimulation, and novelty) surpassed usability quality benchmarks. The qualitative analysis identified 43 usability issues, primarily related to effectiveness and efficiency as defined in ISO 9241-210. In this study, we conducted a usability evaluation of the \"MyPal for adults\" app, a digital tool designed to enhance the palliative care experience. This approach identifies real-world usability issues, enabling iterative improvements in the eHealth platform's design. Our findings reveal a user-friendly interface and positive patient experiences. This study emphasizes the need to enhance mobile health platform usability, offering insights to improve digital palliative care.

Digital health interventions (DHIs) could support prevention and management of cardiometabolic disease. However, those who may benefit most often experience barriers to awareness and adoption of these interventions. Among South Asian individuals, we evaluated user experience of DHIs for prevention and management of cardiometabolic disease, aiming to understand barriers and facilitators to initial and ongoing use. Among South Asian individuals recruited via primary care, community organizations, and snowball methods (n=18), we conducted \"think-aloud\" interviews using a reflective and reactive approach. Participants included nonusers, as well as those that used a range of DHIs as part of monitoring and improving their health. Participants were asked to think aloud while completing a task they routinely do in a familiar DHI, as well as while setting up and completing a search task in a novel DHI; they were encouraged to behave as if unobserved. Lack of cultural specificity was highlighted as reducing relevance and usability, particularly relating to dietary change. Preferred features reflected individual health beliefs and behaviors, digital skills, and trust in DHIs. For example, tracking blood glucose was considered by some to be positive, while for others it caused distress and anxiety. Similarly, some users found the novel DHI to be extremely simple to set up and use, and others grew frustrated navigating through initial interfaces. Many participants raised concerns about data privacy and needing to agree to terms and conditions that they did not understand. Participants expressed that with information and support from trusted sources, they would be interested in using DHIs as part of self-management. DHIs may support South Asians to prevent and manage cardiometabolic disease, but it is important to consider the needs of specific user groups in DHI development, design, and implementation. Despite motivation to make health changes, digital barriers are common. Cultural appropriateness and trusted sources (such as health care providers and community organizations) have roles in increasing awareness and enabling individuals to access and use DHIs.

Type 2 diabetes mellitus (DM2) is a leading cause of morbidity and mortality worldwide and is considered a global epidemic. Despite the growing evidence on the effectiveness of mobile health interventions in the management of DM2, the evidence on the effect of mobile health interventions in prevention of DM2 is sparse. Therefore, we have developed an app aiming to promote initiation of behavioral change and adherence to healthy behavior. Before commencing a small-scale randomized controlled trial to assess the feasibility of using an app for initiation and adherence of healthy behavior in people at risk of DM2, testing the usability of the app in the target population is warranted. The aim of this study was to assess the usability of an app among people at risk of DM2. A qualitative study with the use of a think aloud (TA) procedure was conducted from April to November 2022. The TA procedure consisted of 10 problem-solving tasks and a semistructured interview which was carried out after the tasks. These interviews served to gain more in-depth knowledge of the users experience of the problem-solving tasks. The TA-sessions and the postactivity interviews were recorded and transcribed verbatim, and the data were coded and analyzed following the principles of thematic analysis. In total, 7 people at risk of DM2 with a median age of 66 (range 41-75) years participated in this study. The analysis resulted in the following themes: (1) user interface design; and (2) suggestions for improvements of the functionality of the app. Overall, the participants were satisfied with the usability of the app. Through the TA-sessions, real time perspective on the appeal, relevance, and utility of the app were gained. Only minor changes to the functionality of the prototype app were reported as necessary to improve the usability of the app. Points of guidance from the participants in this study have been adopted and incorporated into the final design of the app now being assessed for feasibility in a small-scale randomized controlled trial.

This article considers the role of reader characteristics in processing and learning from informational text, as revealed in think-aloud research. A theoretical framework for relevant aspects of readers' processing and products was developed. These relevant aspects included three attentional foci for processing (comprehension, monitoring, and evaluation) and five types of processing behaviors (use of strategies, metacognition, monitoring, goal setting and pursuit, and use of prior knowledge). Relevant aspects of products included mental representations of text (textbase, situation model of text, situation model of phenomenon, and author model) and the quality of those representations. A body of 45 studies was identified, considering reader characteristics of ability, experience, knowledge, and interest. Overall, low levels of all these were associated with an emphasis on local-level processing and effortful construction of a textbase, whereas higher levels were associated with more globally directed, more effective, more flexible engagement, leading to better quality mental representations and greater learning.

The eCOVID19 Recommendations Map & Gateway to Contextualization (RecMap) website was developed to identify all COVID-19 guidelines, assess the credibility and trustworthiness of the guidelines, and make recommendations understandable to various stakeholder groups. To date, little has been done to understand and explore parents' experiences when accessing and using the RecMap website for COVID-19 health decision-making. To explore (1) where parents look for COVID-19 health information and why, (2) parents' user experience when accessing and using the RecMap website to make health decisions, and (3) what knowledge mobilization activities are needed to increase parents' awareness, use, and engagement with the RecMap website. We conducted a qualitative descriptive study using semistructured interviews and a think-aloud activity with parents of children aged 18 years or younger living in Canada. Participants were asked to provide feedback on the RecMap website and to \"think aloud\" as they navigated the website to find relevant COVID-19 health recommendations. Demographic information was collected using a web-based questionnaire. A hybrid deductive and inductive thematic approach guided analysis and data synthesis. A total of 21 participants (13/21, 62% mothers) were interviewed and participated in a think-aloud activity. The data were categorized into four sections, representative of key elements that deductively and inductively emerged from the data: (1) parent information seeking behaviors and preferences for COVID-19, (2) RecMap website usability, (3) perceived usefulness of the RecMap website, and (4) knowledge mobilization strategies to increase awareness, use, and engagement of the RecMap website. Parents primarily used the internet to find COVID-19 information and focused on sources that they determined to be credible, trustworthy, simple, and engaging. As the pandemic evolved, participants' information-seeking behaviors changed, specifically their topics of interest and search frequency. Most parents were not aware of the RecMap website before this study but found satisfaction with its concept and layout and expressed intentions to use and share it with others. Parents experienced some barriers to using the RecMap website and suggested key areas for improvement to facilitate its usability and perceived usefulness. Recommendations included a more user-friendly home page for lay audiences (separate public-facing user interface), improving the search and filter options, quicker navigation, clearer titles, more family-friendly graphics, and improving mobile-friendly access. Several strategies to disseminate the RecMap website were also expressed, including a mix of traditional and nontraditional methods (handouts and social media) in credible and high-traffic locations that parents frequent often. Overall, parents liked the concept of the RecMap website but had some suggestions to improve its usability (language, navigation, and website interface). These findings can be used to improve the RecMap website for parents and offer insight for the development and dissemination of effective web-based health information tools and resources for the general public.

Given the current methodological interest in eliciting direct data on the cognitive processes L2 learners employ as they interact with L2 data during the early stages of the learning process, this article takes a critical and comparative look at three concurrent data elicitation procedures currently employed in the SLA literature: Think aloud (TA) protocols, eye-tracking (ET), and reaction time (RT). The section on each data elicitation procedure begins with a brief historical and descriptive account of its usage and application in the SLA literature to address cognitive processes as they occur during the early stages of the L2 learning process, followed by its strengths and some methodological issues that should be considered. Suggestions are provided for their usage in future studies investigating concurrent cognitive processes in L2 learning at these early stages of the L2 learning process.

Teaching and assessing metacognitive activities are important educational objectives, and teachers are calling for efficient instruments. The advantages of questionnaires in measuring metacognitive activities are obvious, but serious validity issues appear. For example, correlations of questionnaire data with think-aloud measures are generally moderate to low. An explanation may be that these questionnaires are not constructed in line with the metacognitive activities measured by the think-aloud method. In the present study, a questionnaire is constructed based directly on a taxonomy for coding think-aloud protocols. Twenty ninth-graders studied a text while thinking aloud, after which they immediately received the questionnaire. The overall correlation between the questionnaire and the think-aloud protocols (r=0.63) was promising. However, scale and item analyses clearly demonstrate some new validity issues. Comparing the questionnaire and the think-aloud results, the students seem to report overt metacognitive activities corresponding more with their behavior reported in the protocols than covert ones. In-depth explorations are presented.