title: The Design and Evaluation of an Innovative Head Mounted Display Counselling Tool for Warfarin
Creators: name: Prenzler, Shane Joseph
Publisher: name: Griffith University
Year: 2019
Subjects: subject: Augmented reality
subject: Head-mounted display
subject: Educational theory
subject: Warfarin
subject: Pharmacy

description: Background Emergent and disruptive technologies such as augmented reality (AR) and head-mounted display (HMD) have not been explored in the context of pharmacy to date despite the potential benefits for the use of these technologies. Patient counselling could be potentially be modulated to better reflect their level of health literacy and the standardisation of the counselling given to each patient. Further benefits may also be seen with the continual education of pharmacists who use the HMD-AR warfarin counselling guide, as pharmacists have been found to favour interactive forms of continuing education. For this reason, a previously validated educational framework was used for the development of the HMD-AR warfarin counselling guide, the mobile augmented reality education (MARE) design framework. The acceptance of the HMD-AR warfarin counselling guide was gauged using the previously validated e-learning technology acceptance model (TAM). The use of TAM gives significant insight into participants perceived ease of use (PEU), perceived usefulness (PU) and their behavioural intention (BI) which correlate highly to actual use of technology being tested. Aims and Objectives: The aim of this study was to develop and test acceptance of a counselling tool for the drug warfarin using both HMD and AR (HMD-AR warfarin counselling guide). The objectives of this study were to (i) conduct background literature research prior to the developments of the HMD-AR warfarin counselling guide, followed by a (ii) pilot study with 7 Griffith University School of Pharmacy and Pharmacology academic staff. Use pilot study feedback to (iii) redevelop the HMD-AR warfarin counselling guide as well as the accompanying adapted TAM survey. Conduct a (iv) larger mixed method cohort study with a pre- and post-test with 40 Australian registered pharmacists. Methods: The HMD-AR warfarin counselling guide was developed in the same documented way as MARE framework. TAM was assessed in the post-test on a five-point Likert scale. The redeveloped HMD-AR warfarin counselling guide used in the larger cohort of 40 pharmacists to gauge acceptance of the redeveloped HMD-AR warfarin counselling guide. Descriptive statistics, two-tailed Spearman’s rank analysis, Wilcoxon signed rank test and qualitative analysis were then utilised. A pre-and post-test assessment was conducted on participants willingness to use technology and the usefulness of HMD-AR warfarin counselling guide. Results and Discussion: It was shown that even though overall each construct of TAM had an average positive result, this fluctuated. PEU was shown to be the best performing construct with an average score of 1.68 on a five-point Likert scale, while BI showed the lowest average score of 2.74. Spearman rank analysis showed the pre-test question regarding usefulness of the HMD-AR warfarin counselling guide was associated with the post-test statements for PU, AT, BI and SN. Wilcoxon signed rank analysis showed both the post-test additional question for usefulness of the HMD-AR warfarin counselling guide (p= 0.005) and willingness to use technology normally (p= 0.025) had declined compared to the same questions in the pre-test. Qualitative feedback was coded to form three major categories which were then split into two sub-categories each. This qualitative feedback showed a negative perception most participants towards the HMD-AR warfarin counselling guide, some praise was seen for the content and potential of the counselling guide itself however. This study was able to document the early acceptance of the HMD-AR warfarin counselling guide with the use of 40 recruited pharmacists. Expectations were higher prior to use of the HMD-AR but dropped after participants trialled the HMD-AR warfarin counselling guide. Perceptions regarding the HMD-AR technology incorporated into this device were more negative compared to the content and information of the counselling guide. This may have influenced the BI construct having a near neutral on average response from participants, this indicated a possible reluctance for actual use of the HMD-AR warfarin counselling guide in practice. This was despite other constructs of TAM like PEU having a more positive average score indicating participants found the HMD-AR warfarin counselling guide easy to use. Conclusion: This study was successful in developing the HMD-AR warfarin counselling guide and testing for acceptance. Current technology available fell below expectations of usefulness for most participants. Future applications of this technology could mean the use of HMD-AR technology for other drugs. Further research would need to be conducted on a larger sample of participants from more diverse professional backgrounds in order further understand acceptance.