Sticky apps, not sticky hands: A systematic review and content synthesis of hand hygiene mobile apps

Gasteiger, Norina; Dowding, Dawn; Ali, Syed Mustafa; Scott, Ashley; Wilson, Paul; Veer, Sabine N van der

doi:10.1093/jamia/ocab094

Cited by 19 publications

(27 citation statements)

References 47 publications

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“…There was a clear absence of AR and VR training programs for allied health staff, care workers, and within care- and community-based settings. There was also less focus on simple behavioral skills such as disposing of hazardous medical waste or practicing hand hygiene, for which AR and VR smartphone apps have already been developed [ 109 ]. In addition, many of the VR and AR devices were used along with haptics, robotic arms, actors, or manikins, which may introduce confounding factors when exploring effectiveness.…”

Section: Discussionmentioning

confidence: 99%

How, for Whom, and in Which Contexts or Conditions Augmented and Virtual Reality Training Works in Upskilling Health Care Workers: Realist Synthesis

Gasteiger¹,

Veer²,

Wilson³

et al. 2022

JMIR Serious Games

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Background Using traditional simulators (eg, cadavers, animals, or actors) to upskill health workers is becoming less common because of ethical issues, commitment to patient safety, and cost and resource restrictions. Virtual reality (VR) and augmented reality (AR) may help to overcome these barriers. However, their effectiveness is often contested and poorly understood and warrants further investigation. Objective The aim of this review is to develop, test, and refine an evidence-informed program theory on how, for whom, and to what extent training using AR or VR works for upskilling health care workers and to understand what facilitates or constrains their implementation and maintenance. Methods We conducted a realist synthesis using the following 3-step process: theory elicitation, theory testing, and theory refinement. We first searched 7 databases and 11 practitioner journals for literature on AR or VR used to train health care staff. In total, 80 papers were identified, and information regarding context-mechanism-outcome (CMO) was extracted. We conducted a narrative synthesis to form an initial program theory comprising of CMO configurations. To refine and test this theory, we identified empirical studies through a second search of the same databases used in the first search. We used the Mixed Methods Appraisal Tool to assess the quality of the studies and to determine our confidence in each CMO configuration. Results Of the 41 CMO configurations identified, we had moderate to high confidence in 9 (22%) based on 46 empirical studies reporting on VR, AR, or mixed simulation training programs. These stated that realistic (high-fidelity) simulations trigger perceptions of realism, easier visualization of patient anatomy, and an interactive experience, which result in increased learner satisfaction and more effective learning. Immersive VR or AR engages learners in deep immersion and improves learning and skill performance. When transferable skills and knowledge are taught using VR or AR, skills are enhanced and practiced in a safe environment, leading to knowledge and skill transfer to clinical practice. Finally, for novices, VR or AR enables repeated practice, resulting in technical proficiency, skill acquisition, and improved performance. The most common barriers to implementation were up-front costs, negative attitudes and experiences (ie, cybersickness), developmental and logistical considerations, and the complexity of creating a curriculum. Facilitating factors included decreasing costs through commercialization, increasing the cost-effectiveness of training, a cultural shift toward acceptance, access to training, and leadership and collaboration. Conclusions Technical and nontechnical skills training programs using AR or VR for health care staff may trigger perceptions of realism and deep immersion and enable easier visualization, interactivity, enhanced skills, and repeated practice in a safe environment. This may improve skills and increase learning, knowledge, and learner satisfaction. The future testing of these mechanisms using hypothesis-driven approaches is required. Research is also required to explore implementation considerations.

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Section: Discussionmentioning

confidence: 99%

How, for Whom, and in Which Contexts or Conditions Augmented and Virtual Reality Training Works in Upskilling Health Care Workers: Realist Synthesis

Gasteiger¹,

Veer²,

Wilson³

et al. 2022

JMIR Serious Games

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“…Informed by previous app reviews (Ali et al 2020;Gasteiger et al 2021), a coding sheet was created on Microsoft Excel, into which three raters (AV, NG and AD) extracted data from the apps (see Table 1). Descriptive information included the app's name, developer, version number, the app market/s in which it was available, cost to download, whether it was affiliated with a professional health/medical body or charity, average user rating, and the number of user ratings.…”

Section: Data Extractionmentioning

confidence: 99%

“…As in other systematic app reviews (Ali et al 2020;Gasteiger et al 2021;Grainger et al 2017;Kim et al 2018;Talwar et al 2019), the Mobile App Rating Scale (Stoyanov et al 2015) was used to determine the quality of each app. The MARS consists of 19 items across four dimensions (engagement, functionality, aesthetics, and information quality), with each item rated on a 5-point Likert scale: (1) inadequate, (2) poor, (3) acceptable, (4) good, and (5) excellent.…”

Section: Data Extractionmentioning

confidence: 99%

“…The MARS consists of 19 items across four dimensions (engagement, functionality, aesthetics, and information quality), with each item rated on a 5-point Likert scale: (1) inadequate, (2) poor, (3) acceptable, (4) good, and (5) excellent. As in previous app reviews, the optional subscale for subjective quality was omitted to ensure that quality assessments were only objective (Ali et al 2020;Bardus et al 2016;Gasteiger et al 2021;Kim et al 2018).…”

Section: Data Extractionmentioning

confidence: 99%

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Patient-facing genetic and genomic mobile apps in the UK: a systematic review of content, functionality, and quality

et al. 2022

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Close relative (consanguineous) marriage is widely practised globally, and it increases the risk of genetic disorders. Mobile apps may increase awareness and education regarding the associated risks in a sensitive, engaging, and accessible manner. This systematic review of patient-facing genetic/genomic mobile apps explores content, function, and quality. We searched the NHS Apps Library and the UK Google Play and Apple App stores for patient-facing genomic/genetic smartphone apps. Descriptive information and information on content was extracted and summarized. Readability was examined using the Flesch–Kincaid metrics. Two raters assessed each app, using the Mobile App Rating Scale (MARS) and the IMS Institute for Healthcare Informatics functionality score. A total of 754 apps were identified, of which 22 met the eligibility criteria. All apps intended to inform/educate users, while 32% analyzed genetic data, and 18% helped to diagnose genetic conditions. Most (68%) were clearly about genetics, but only 14% were affiliated with a medical/health body or charity, and only 36% had a privacy strategy. Mean reading scores were 35 (of 100), with the average reading age being equivalent to US grade 12 (UK year 13). On average, apps had 3.3 of the 11 IMS functionality criteria. The mean MARS quality score was 3.2 ± 0.7. Half met the minimum acceptability score (3 of 5). None had been formally evaluated. It was evident that there are few high-quality genomic/genetic patient-facing apps available in the UK. This demonstrates a need for an accessible, culturally sensitive, evidence-based app to improve genetic literacy within patient populations and specific communities.

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“…Other tools include the AR xVision 55 three-dimensional anatomical images that enable clinical providers to see a patient's skin and tissue (akin to X-ray vision) and the AR SureWash 56 mobile app, which provides personalised feedback for hand hygiene technique. 57 VR technologies were also implemented during the COVID-19 pandemic when face-to-face teaching was not possible. 58 For example, St Bartholomew's Hospital used VR to train their nurses and doctors on 50 clinical procedures.…”

Section: Simulation Technologies For Upskillingmentioning

confidence: 99%

Upskilling health and care workers with augmented and virtual reality: protocol for a realist review to develop an evidence-informed programme theory

et al. 2021

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IntroductionAugmented reality (AR) and virtual reality (VR) are increasingly used to upskill health and care providers, including in surgical, nursing and acute care settings. Many studies have used AR/VR to deliver training, providing mixed evidence on their effectiveness and limited evidence regarding contextual factors that influence effectiveness and implementation. This review will develop, test and refine an evidence-informed programme theory on what facilitates or constrains the implementation of AR or VR programmes in health and care settings and understand how, for whom and to what extent they ‘work’.Methods and analysisThis realist review adheres to the Realist And Meta-narrative Evidence Syntheses: Evolving Standards (RAMESES) standards and will be conducted in three steps: theory elicitation, theory testing and theory refinement. First, a search will identify practitioner, academic and learning and technology adoption theories from databases (MEDLINE, Scopus, CINAHL, Embase, Education Resources Information Center, PsycINFO and Web of Science), practitioner journals, snowballing and grey literature. Information regarding contexts, mechanisms and outcomes will be extracted. A narrative synthesis will determine overlapping configurations and form an initial theory. Second, the theory will be tested using empirical evidence located from the above databases and identified from the first search. Quality will be assessed using the Mixed Methods Appraisal Tool (MMAT), and relevant information will be extracted into a coding sheet. Third, the extracted information will be compared with the initial programme theory, with differences helping to make refinements. Findings will be presented as a narrative summary, and the MMAT will determine our confidence in each configuration.Ethics and disseminationEthics approval is not required. This review will develop an evidence-informed programme theory. The results will inform and support AR/VR interventions from clinical educators, healthcare providers and software developers. Upskilling through AR/VR learning interventions may improve quality of care and promote evidence-based practice and continued learning. Findings will be disseminated through conference presentations and peer-reviewed journal articles.

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Sticky apps, not sticky hands: A systematic review and content synthesis of hand hygiene mobile apps

Cited by 19 publications

References 47 publications

How, for Whom, and in Which Contexts or Conditions Augmented and Virtual Reality Training Works in Upskilling Health Care Workers: Realist Synthesis

How, for Whom, and in Which Contexts or Conditions Augmented and Virtual Reality Training Works in Upskilling Health Care Workers: Realist Synthesis

Patient-facing genetic and genomic mobile apps in the UK: a systematic review of content, functionality, and quality

Upskilling health and care workers with augmented and virtual reality: protocol for a realist review to develop an evidence-informed programme theory

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