A Design-Driven Approach to Develop Innovative Clinical Experiences in Dysphagia

I ask in this essay: How do user-centered design studies contribute to cartography? Scholars in related fields increasingly recognize the intellectual value of employing user-centered processes to improve a single product and identify new design considerations for future products. To this end, I propose an analytical framework for organizing the contributions of user-centered design studies that includes eight opportunities for advancing cartography: (1) domain gap analyses, (2) adapted or novel user-centered methods, (3) streamlined user-centered design processes, (4) transferable design insights, (5) comprehensive user-centered design case studies, (6) novel or unique maps and visualizations, (7) summative controlled experiments, and (8) new insights into pressing geographic problems. I apply this framework against my own collaborative work in a retrospective analysis of three UCD case studies: the GeoVISTA CrimeViz visual analytics tool, the NOAA Lake Level Viewer climate change visualization, and the UW Cart Lab Global Madison mobile map.

The rapid advancement of AI technology has led to increasingly complex and opaque systems, creating a critical need for explainable AI (XAI) that enhances transparency and user trust. Despite extensive research on XAI methods and applications, the user-centered design (UCD) process for XAI remains fragmented and unclear. This systematic review analyzes 27 studies from 2020 to 2024 to develop a comprehensive framework for user-centered XAI system design (UCXAISD). We identify five key stages: contextual inquiry, explanation needs identification, XAI method selection, user interface design, and evaluation and refinement. Our framework aligns with traditional UCD processes while incorporating specialized elements for XAI, including user-centricity, transparency, and actionability. For each stage, we provide evidence-based guidelines derived from the literature. The framework serves as a blueprint for developing XAI systems that balance technical sophistication with user needs.

Policymakers and environmental organizations are increasingly implementing gamification because of its ability to stimulate playful learning and transform human attitudes and behavior. Although it has become a prominent development for climate change engagement, the literature does not adequately address how the underlying motivational systems depend upon user-centered design mechanisms. If gamification is to realize its potential for climate change engagement, it is crucial for designers to apply solid user-centered design principles, as suboptimal designs may do more harm than good. Therefore, we conducted a systematic literature review on gamification for climate change engagement to investigate the application of user-centered design and find key links between design choices and outcomes in 64 articles. We develop the findings into a user-centered design agenda and framework for game-based climate change engagement. This agenda includes design aspects–team multidisciplinarity, context dependence, user involvement, iterative testing, and design choice explication–and outcome aspects–value to users, game mechanics for learning, game content for learning, affective engagement, social engagement, changing real-world behavior, and using game data for research. The agenda is intended to inform gamification academics and practitioners aiming to design effective games for climate change engagement and its recommendations may apply to other complex issues.

This paper presents two case studies that suggest how to adapt Scrum for user-centered design (UCD) focused industrial projects and how to work with UCD in Scrum software development teams. The objective of the paper is to share insights gained from running such combined projects in industry in order to help others avoid some of the pitfalls associated with this way of working. There has been much published in this area within the research community. However, our work presents both perspectives: adapting a UCD way of working towards a Scrum way of working; and adapting Scrum for running projects from a UCD perspective. We explore the impact Scrum had on team members’ work-practices during a project life-cycle and what lessons were learned from our experiences.

This year's article on health information technology (HIT) illustrates the use of digital technology to prevent and treat diabetes by enabling consumer engagement, behavior change, and impact analytics. It provides a snapshot of current thinking about digital technology's capabilities and capacity to deliver personalized interventions at scale. Early results are promising. A growing number of digital programs are clinically proven to improve health and lower the cost of care. And pioneering health-care organizations are offering these programs to members and patients as part of their new models for value-based care. Their success will drive other organizations—payers, providers, and employers—to make similar investments in health. In the modern health-care world, experts agree that “value” will be created by enabling health, not just delivering care. With today's epidemic of diabetes, patients who use digital health technologies can benefit greatly from both short-term health improvements and long-term health self-management. The foundations have been laid with evidence-based programs. Now, more health-care organizations must embrace this population management strategy for health. As adoption increases, the next technology challenge will arise: consumer engagement at scale. This engagement will be digital: content-rich programs filled with social support to activate, educate, and engage consumers. Most of the articles included in this and prior ATTD Yearbook articles address the specifics of digital interventions once the person enrolls. But before enrollment, consumers must engage. And to engage consumers, one must understand their reasons for engaging and their expectations for results. These insights fall into the realm of digital marketing, rather than the domain of clinical programs. Using a multidisciplinary approach, digital engagement will be the next variable to solve in the equation for scalable digital health. Not for a lack of trying, we have been unable to find noteworthy articles presenting best practices for consumer engagement from outreach to enrollment. But the future looks quite bright for the science of marketing digital health interventions. Increasingly, “big data” is providing scientists, innovators, entrepreneurs, educators, health-care providers, and administrators with the insights they need to predict consumer interests and personalize experiences throughout the entire behavior change process—from outreach to outcomes. Over the coming year, we will continue to search the health-care landscape to bring more innovations in digital health and diabetes prevention, from consumer engagement to population impact.

This paper discusses results from a research study in the design and implementation of information documents and products in the Australian Taxation Office (ATO). It presents a composite ethnographic and case study analysis of user-centred information design practices at the ATO from 2001-2005, and shows that the ATO has been an active proponent of user centred design practices in developing business information documents and products for an extended period of time, while also identifying potential opportunities to improve business simulation, design and product construction. The article highlights that user-centred design principles may have broad based application in both the public and private sectors.

User Needs Analysis and requirements engineering: Theory and practice

BackgroundDeaths from opioid overdose have increased dramatically in the past decade. For individuals with opioid use disorder (OUD), agonist medications such as methadone and buprenorphine reduce opioid-related morbidity and mortality. Historically, the provision of buprenorphine treatment in office-based settings has relied on frequent in-person contact, likely influencing patients’ access to and retention in care. In response to the COVID-19 pandemic, providers of office-based buprenorphine treatment rapidly adapted their care processes, increasingly relying on telemedicine visits. To date, relatively few prior studies have combined patient and clinician perspectives to examine the implementation of telemedicine and related care adaptations, particularly in safety-net settings.MethodsQualitative methods were used to explore clinician and patient experiences with telemedicine in an office-based buprenorphine treatment clinic affiliated with an urban safety-net hospital. From this clinic, we conducted semi-structured interviews with 25 patients and 16 clinicians (including prescribers and non-prescribers). We coded all interview data and used a thematic analysis approach to understand how telemedicine impacted treatment quality and engagement in care, as well as preferences for using telemedicine moving forward.ResultsFive themes regarding the implementation of telemedicine and other COVID-19-related care adaptations arose from patient and clinician perspectives: (1) telemedicine integration precipitated openness to more flexibility in care practices, (2) concerns regarding telemedicine-related adaptations centered around safety and accountability, (3) telemedicine encounters required rapport and trust between patients and clinicians to facilitate open communication, (4) safety-net patient populations experienced unique challenges when using telemedicine, particularly in terms of the technology required and the need for privacy, and (5) there is an important role for telemedicine in office-based buprenorphine treatment moving forward, primarily through its use in hybrid models of care which integrate both in-person and virtual visits.ConclusionsTelemedicine implementation within office-based buprenorphine treatment has the potential to improve patients’ engagement in care; however, our findings emphasize the need for tailored approaches to implementing telemedicine in office-based buprenorphine treatment, particularly within safety-net settings. Overall, this study supports the maintenance of changes to policy and practice that facilitate the use of telemedicine in office-based buprenorphine treatment beyond the COVID-19 public health emergency.

In a previous study, we analyzed data from a field study to determine the usability problems in a groupware system. That 75% of the system use was asynchronous surprised us. Consequently, we suspected that the user-centered method that had been employed in that evaluation, might have been insufficient to detect problems related to such heavy asynchronous use. Re-analysis of the data using an artifact-centered approach revealed additional support for our initial findings and some new usability issues. In combination, we believe that user-centered and artifact- centered methods can yield superior usability analyses for systems that support both synchronous and asynchronous collaboration, and provide application developers with more appropriate priorities for addressing usability problems and system design.

In the UK outpatient services are a major element of the health service for older people and large numbers are requested to attend hospital-based outpatient clinics. However, it has been reported that outpatient clinics have fallen behind improvements in inpatient and primary care and they are seldom the focus of the patient-centred quality agenda that promotes personalised care. Significant proportions of older people fail to attend their appointments and there are few studies into the experience of older patients using outpatient services. In this paper we report on a design-led service improvement project that involved older people using a medical outpatient service and its staff. The project was facilitated by an interdisciplinary user-centred healthcare design team consisting of designers, technologists and health professionals formed to develop new participatory design methodologies and translate design thinking and practices into health services. A significant finding of the project is that an outpatient service extends beyond both the clinical encounter and the physical extent of the building, with many touchpoints before and after an appointment, such as confirmation letters, journeys and wayfinding, and staff interactions. These significant interfaces and interactions constitute critical factors in the experience of patients and staff and impact upon the ability of the service to perform its clinical role. We argue that through the deep engagement, achieved by capturing the lived experience of patients and staff, the clinic can be reconceived and reconstructed from a user perspective and thus improve its clinical effectiveness and enhance the quality of its service. We discuss the benefits and practicalities of using an experience-based approach to service improvement in health care, and we describe the improvements and changes co-produced with the users of this outpatient system.

University of Virginia School of Medicine.

In H. G. Well's The Island of Dr. Moreau, the sinister doctor grows bizarre creatures of flesh and bone to further his vast and evil ambitions. In Isaac Asimov's world of the near future, robots manufactured from metals and polymers are governed by rational principles and serve their human masters for more domestic reasons. In our own age we have the means to construct entities as outlandish as Moreau's and as helpful as Asimov's, made up of hardware, software and the engaged human mind. These new organisms are not motivated by an external spark or by a set of self-contained algorithms. They are animated by the direct involvement of a person or community and by human knowledge stored, accessed and shared. We are the ghost in the web machine. A website's information architecture (IA) is the framework, the skeleton upon which the whole organism of the site stands up. IA gives a site its articulation and therefore its potential to grow into whatever sort of thing it will be. A good IA can be simple and elegant, or complex and engaging. A bad or accidental IA could resemble something that lumbered out of a mad scientist's vat. Digital libraries are often grown over time out of perfectly good but originally unrelated pieces and are particularly at risk of becoming Moreauvian nightmares. To avoid such mistakes you need a good plan and a well-considered approach. IA methodology will give you the blueprints for building a much better digital library. Since the human mind animates the website, the user must be at the center of the web design process. And since design products have to move back and forth during their creation among a number of people—design team members, stakeholders, end users and developers—the web design process should be iterative. User-centered design (UCD) brings representatives from all concerned parties into the process, and iteration allows design to be refined from broad to finely detailed. These methods also help the team figure out which tasks are important to a particular project, get buy-in where needed, creatively manage the tricky parts that come up and roll out a successful web application or site. Navigation, labels and information organization Interactions between user and different parts of the website Relationships between the site and other objects in its environment (search engines, other sites that can contribute or use digital library information, enterprise-wide navigation and more) IA uses user-centered design practices in conjunction with other methods to arrive at these blueprints. An upcoming LITA guide (http://www.lita.org/) showcases projects that apply user-centered design techniques to improve public and special library websites. Edited by Tom Lehman and Terry Nikkel, Making Library Websites Usable, will offer methodologies and case studies to put powerful tools into the right hands. I contributed a case study describing a website redesign for a corporate knowledge services department. As I organized my thoughts for that article I saw that most problems were not unique to digital libraries or knowledge services organizations. Also, the UCD and IA practices we followed can be applied to any complex information space. However, two issues emerged that do pertain specifically to digital libraries. They are designing good interfaces for lists and crafting the user experience when target objects lie outside the digital library. Digital library listings follow various models. Some look like Google results pages. Some replicate card catalogs. Others are bulleted lists or tables. In each case the person designing the list interface has to select which attributes to display for each information object. This decision should not be primarily technological (“all these fields are available in the database, so let's show them”) nor even a cultural one (“we're used to seeing bulleted lists, so we'll do it that way”). Rather, the design should revolve around the user's situation and tasks. The key to designing a useful digital library listing lies in understanding which combination of attributes will help your audience find the resources they're looking for. UCD techniques are effective means to gaining this understanding. The IA challenge is then to arrange an optimal layout and navigation of digital library listings so users can find the resources they need. Imagine you're browsing the magazine racks at your favorite local bookstore. You reach out to pick up an issue of Sunset magazine. You don't expect to find yourself suddenly transported to the publisher's offices in Menlo Park, California. You count on staying right there in the bookstore—otherwise you'd find yourself stumped if what you really needed was a copy of Wired. When browsing in a digital library, the work you ultimately wish to reach might reside anywhere. It may be inside the current collection or somewhere else on the corporate intranet, or it could be behind the login page of a service to which your digital library subscribes. The link you see in the listing might be a link to the thing itself or it might be a jump-off page for yet another digital library with its own navigation scheme and listing style. What lies beyond your home digital library page is an unpredictable and generally frustrating treasure hunt. How do we design the user experience to include smooth transitions between the digital library home page, a filtered list of results and the new interface that may arise when clicking through? Should we—or can we—bring target objects into the sphere of our own digital library? Can we subsume subscription login under the corporate or library login? Or must users be on their own once they reach for certain sorts of information objects? And if they must, how do we ease the path for them? These questions arise out of a user-centered design approach and move us some distance towards a workable solution. But until service-oriented architectures are widely in place, workarounds need to start with a square look at the problem. Each design team must proceed to make considered decisions on how best to smooth the way for their users. Websites are becoming more responsive to the impulses of individuals and communities. The best-behaved sites react to users' actions in natural ways. They anticipate needs in a non-intrusive manner, play nicely with other web and non-web tools, let users do interactive things like add and tag content and work collaboratively in groups, and don't force users into awkward positions in order to work with the site. People are coming to expect websites to be shaped to fit them, and digital libraries need to live up to this promise. Fortunately, with information architecture methodologies, a user-centered design approach and sensible project management, you have the tools to build fully articulated frameworks for all kinds of web creations. All that remains to animate your site is the spark of your inspiration—and the eager participation of your delighted users.

Scientific applications built on wide-area distributed systems such as emerging cloud based architectures and the legacy grid computing infrastructure often struggle with user adoption even though they succeed from a systems research perspective. This paper examines the coupling of user-centered design processes with modern distributed systems. Further in this paper, we describe approaches for conceptualizing a product that solves a recognized need: to develop a data gateway to serve the data management and research needs of experimentalists of electron microscopes and similar shared scientific instruments in the context of a research service laboratory. The purpose of the data gateway is to provide secure, controlled access to data generated from a wide range of scientific instruments. From the functional perspective, we focus on the basic processing of raw data that underlies the lab’s business processes, the movement of data from the laboratory to central access and archival storage points, and the distribution of data to respective authorized users. Through the gateway interface, users will be able to share the instrument data with collaborators or copy it to remote storage servers. Basic pipelines for extracting additional metadata (through a pluggable parser framework) will be enabled. The core contribution described in this paper, building on the aforementioned distributed data management capabilities, is the adoption of user-centered design processes for developing the scientific user interface. We describe the user-centered design methodology for exploring user needs, iteratively testing the design, learning from user experiences, and adapting what we learn to improve design and capabilities. We further conclude that user-centered design is, in turn, best enabled by an adaptable distributed systems framework. A key challenge to implementing a user-centered design is to have design tools closely linked with a software system architecture that can evolve over time while providing a highly available data gateway. A key contribution of this paper is to share the insights from crafting such an evolvable design-build-evaluate-deploy architecture and plans for iterative development and deployment.

A rapid expansion of systemic immunological treatment options for atopic dermatitis (AD) has created a need for clinically relevant and understandable comparative efficacy and safety information for patients and clinicians. Given the scarcity of head-to-head trials, network meta-analysis (NMA) is an alternative way to enable robust comparisons among treatment options; however, NMA results are often complex and difficult to directly implement in shared decision-making. The aim of this study is to develop a website that effectively presents the results of a living systematic review and NMA on AD treatments to patient and clinician users. We conducted a multimethod study using iterative feedback from adults with AD, adult caregivers of children with AD, dermatologists, and allergists within a user-centered design framework. We used questionnaires followed by workshops among patients and clinicians to develop and improve the website interface. Usability testing was done with a caregiver of a patient with eczema. Questionnaires were completed by 31 adults with AD or caregivers and 94 clinicians. Patients and caregivers felt it was very important to know about new treatments (20/31, 65%). Clinicians felt the lack of evidence-based comparisons between treatments was a barrier to care (55/93, 59%). "Avoiding dangerous side effects" was ranked as the most important priority for patients (weighted ranking 5.2/7, with higher ranking being more important), and "improving patients' overall symptoms" was the most important priority for clinicians (weighted ranking 5.0/6). A total of 4 patients and 7 clinicians participated in workshops; they appreciated visualizations of the NMA results and found the website valuable for comparing different treatments. The patients suggested changes to simplify the interface and clarify terminology related to comparative efficacy. The user in the usability testing found the website intuitive to navigate. We developed a website, "eczematherapies.com," with a user-centered design approach. Visualizations of NMA results enable users to compare treatments as part of their shared decision-making process.

This study presents a case study of the integration of usability evaluation into the development of task based information system prototypes in undergraduate software engineering course projects within a problem-based learning (PBL) approach. As part of the course, usability evaluation was integrated into the software development process, and the usability evaluation performance (UEP) of the projects was assessed in terms of the following criteria: effectiveness, efficiency and problem validity. It also analyzed the problem solution rate of the projects and their correlation between UEP criteria. Additionally, the study in-depth analyzed the students' final conclusions regarding the design process. The relationship between UEP criteria and the problem solving rate was examined using Spearman correlation analysis. In addition, final conclusions and problem solving behaviors were analyzed through document and thematic analysis techniques. The results supported that there is a significant correlation between usability evaluation criteria and problem solving rate. The main themes that emerged regarding usability problem solving behaviors were navigation design, error handling, database connection, algorithm design, search matching, system-user communication design and others. Final conclusions showed that project teams gained valuable insights into user-centered design, solved critical usability problems and improved their prototype design. It can be concluded that the integration of usability into software engineering education using the above approach contributes to students' understanding of user-centered interaction design.