Crafting a case-finder of traumatic brain injury for patients and staff in community drug and alcohol treatment

Purpose: To develop a user interface with embedded clinical decision support software for detecting self or proxy reports of lifetime exposure to TBI with patients receiving community drug and alcohol treatment. Method: Human centred design standard was adopted in the adaptation of the Ohio State University Traumatic Brain Injury Identification Method. A prototype head injury survey user interface was developed following usability design guidelines with stakeholder involvement. The initial instrument design underwent formative usability evaluation using cognitive walkthrough with a concurrent embedded mixed methods design. Four patients and four staff from a community drug and alcohol treatment service were purposively recruited for usability testing. Results: A thematic analysis was conducted and three themes were identified; user interface problems and improvements, living with TBI, and high tech or low tech healthcare. The theme user interface problems and improvements was quantified using problem discovery analysis to prioritise the five pre-defined user interface categories; navigation, content, page layout, terminology, data entry and technology for redesign (Rubin, 1996). Patients’ highest redesign priority was navigation and for staff it was data entry and technology. Design recommendations: The prototype head injury survey application had ten user interface design recommendations. The next design iteration will be sensitive to neurological deficits, limited IT skills and low reading ability. Several implications for practice in conducting TBI screening were identified. Staff should retain control over the administration of the head injury survey application as the recollection of past traumatic events was distressing for patients. Family and friends should be involved in TBI screening to help differentiate any changes in neurological functioning post head injury. Administration of the instrument should be restricted. Preferred delivery method was clinical interview using mobile computer technology. Electronic healthcare records could provide prompts to conduct TBI screening if associated clinical markers for head trauma have been detected.