{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,6,30]],"date-time":"2026-06-30T19:04:21Z","timestamp":1782846261543,"version":"3.54.5"},"reference-count":46,"publisher":"JMIR Publications Inc.","content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["JMIR Form Res"],"abstract":"<jats:title>Abstract<\/jats:title>\n                  <jats:sec sec-type=\"background\">\n                    <jats:title>Background<\/jats:title>\n                    <jats:p>Hemophilia A is an inherited bleeding disorder with an increased risk of excessive bleeding. People affected by hemophilia A with a severe bleeding phenotype are treated prophylactically with hemostatic agents. Monitoring treatment and adjusting it to the individual patient\u2019s needs is complicated by the scarcity of laboratories equipped to perform relevant coagulation assays and the absence of point-of-care testing platforms. A novel near-patient testing platform called the EnzySystem HemA aims to address this issue by measuring factor VIII (FVIII) activity and thrombin generation within 1 hour of 100 \u00b5L of whole blood.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec sec-type=\"objective\">\n                    <jats:title>Objective<\/jats:title>\n                    <jats:p>This study assessed the usability of the EnzySystem HemA by health care professionals without prior training and gathered information on its perceived usability, effectiveness, usefulness, and acceptability.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec sec-type=\"methods\">\n                    <jats:title>Methods<\/jats:title>\n                    <jats:p>A qualitative, single-center formative usability assessment was performed. Participants performed an FVIII activity assay with a mockup of the EnzySystem HemA and were interviewed about its acceptability, usability, effectiveness, and usefulness. Video recordings of the sessions were obtained with permission and subsequently reviewed to assess usability; thematic analysis was performed on the interview transcripts.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec sec-type=\"results\">\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>\n                      A total of 7 health care providers participated, all unaffiliated with the EnzySystem\u2019s developer. Participants included 1 (14%) pediatric hematologist, 3 (43%; pediatric) nurses, and 3 (43%; pediatric) nurse practitioners. Two (29%) of the participants also held management positions. Five (71%) participants successfully performed the FVIII activity assay as intended. Of the remaining 2 participants, one applied insufficient force when inserting the blood tube, whereas the other was unable to transfer the blood into the EnzySystem. This latter step caused difficulties in 3 (60%) other participants; however, they completed it correctly. Five (71%) participants did not dispose of the EnzySystem components as intended, primarily due to compatibility issues of the disposable parts with the inlet of the US standard medical waste containers. Five themes were generated from the interviews:\n                      <jats:italic>functional the way it is<\/jats:italic>\n                      focuses on the acceptance of the prototype despite suggestions for various improvements,\n                      <jats:italic>utility through faster results and increased access<\/jats:italic>\n                      and\n                      <jats:italic>potential for patient engagement<\/jats:italic>\n                      relate to the envisioned benefits of the platform, and\n                      <jats:italic>financial investment and return<\/jats:italic>\n                      and\n                      <jats:italic>ensuring accuracy<\/jats:italic>\n                      reflect on potential barriers for implementation.\n                    <\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec sec-type=\"conclusions\">\n                    <jats:title>Conclusions<\/jats:title>\n                    <jats:p>Despite significant usability issues, the need for faster and more accessible testing led participants to conclude that the current platform was acceptable for use, provided that proof of assay accuracy was demonstrated. The results of this study will form the basis for further development of the EnzySystem HemA. The effectiveness of any updates will be evaluated in future usability studies, which will also include people with hemophilia A as participants.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.2196\/77621","type":"journal-article","created":{"date-parts":[[2025,10,16]],"date-time":"2025-10-16T18:11:50Z","timestamp":1760638310000},"page":"e77621-e77621","source":"Crossref","is-referenced-by-count":2,"title":["Measuring FVIII Activity and Thrombin Generation Simultaneously With a Novel Point of Care Platform (EnzySystem HemA): Qualitative Usability Evaluation"],"prefix":"10.2196","volume":"9","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-8448-9151","authenticated-orcid":false,"given":"Aernoud","family":"Bavinck","sequence":"first","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-2423-2829","authenticated-orcid":false,"given":"Saskia E M","family":"Schols","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0009-0000-1748-5444","authenticated-orcid":false,"given":"Wilfred","family":"Teunissen","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-2821-7159","authenticated-orcid":false,"given":"Amy","family":"Shapiro","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-1801-2072","authenticated-orcid":false,"given":"Nicole M A","family":"Blijlevens","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0009-0003-1272-1307","authenticated-orcid":false,"given":"Kyle","family":"Davis","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-7101-8775","authenticated-orcid":false,"given":"Waander","family":"van Heerde","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1010","published-online":{"date-parts":[[2025,10,16]]},"reference":[{"issue":"4","key":"R1","doi-asserted-by":"publisher","first-page":"550","DOI":"10.1111\/hae.12381","article-title":"Diagnosis and management challenges in patients with mild haemophilia A and discrepant FVIII measurements","volume":"20","author":"Trossaert","journal-title":"Haemophilia"},{"issue":"5","key":"R2","doi-asserted-by":"publisher","first-page":"438","DOI":"10.1111\/j.1365-2516.2005.01124.x","article-title":"Variability in clinical phenotype of severe haemophilia: the role of the first joint bleed","volume":"11","author":"van Dijk","journal-title":"Haemophilia"},{"issue":"1","key":"R3","doi-asserted-by":"publisher","first-page":"41","DOI":"10.1111\/j.1365-2516.2010.02383.x","article-title":"Analysis of low frequency bleeding data: the association of joint bleeds according to baseline FVIII activity levels","volume":"17","author":"den Uijl","journal-title":"Haemophilia"},{"issue":"S6","key":"R4","doi-asserted-by":"publisher","first-page":"1","DOI":"10.1111\/hae.14046","article-title":"WFH Guidelines for the Management of Hemophilia, 3rd edition","volume":"26 Suppl 6","author":"Srivastava","journal-title":"Haemophilia"},{"issue":"5","key":"R5","doi-asserted-by":"publisher","first-page":"1105","DOI":"10.1111\/jth.13298","article-title":"When and how to start prophylaxis in boys with severe hemophilia without inhibitors: communication from the SSC of the ISTH","volume":"14","author":"Fischer","journal-title":"J Thromb Haemost"},{"issue":"3","key":"R6","doi-asserted-by":"publisher","first-page":"475","DOI":"10.1160\/TH04-10-0706","article-title":"Evaluation of thrombin generating capacity in plasma from patients with haemophilia A and B","volume":"93","author":"Dargaud","journal-title":"Thromb Haemost"},{"issue":"4","key":"R7","doi-asserted-by":"publisher","first-page":"619","DOI":"10.1111\/hae.13493","article-title":"Individual thrombin generation and spontaneous bleeding rate during personalized prophylaxis with Nuwiq (human-cl rhFVIII) in previously treated patients with severe haemophilia A","volume":"24","author":"Dargaud","journal-title":"Haemophilia"},{"issue":"2","key":"R8","doi-asserted-by":"publisher","first-page":"228","DOI":"10.1111\/hae.13935","article-title":"A new paradigm for personalized prophylaxis for patients with severe haemophilia A","volume":"26","author":"Delavenne","journal-title":"Haemophilia"},{"issue":"6","key":"R9","doi-asserted-by":"publisher","first-page":"1242","DOI":"10.1111\/jth.14784","article-title":"Laboratory testing in hemophilia: impact of factor and non-factor replacement therapy on coagulation assays","volume":"18","author":"Peyvandi","journal-title":"J Thromb Haemost"},{"issue":"9","key":"R10","doi-asserted-by":"publisher","first-page":"2111","DOI":"10.1182\/bloodadvances.2019000849","article-title":"Laboratory monitoring of hemophilia A treatments: new challenges","volume":"4","author":"Lenting","journal-title":"Blood Adv"},{"key":"R11","unstructured":"Kost GJ , editor. Principles & Practice of Point-of-Care Testing. Lippincott Williams & Wilkins; 2002. ISBN: 0781731569"},{"issue":"2","key":"R12","doi-asserted-by":"publisher","first-page":"83","DOI":"10.1039\/b106958f","article-title":"Trends in miniaturized total analysis systems for point-of-care testing in clinical chemistry","volume":"1","author":"Tudos","journal-title":"Lab Chip"},{"issue":"6","key":"R13","doi-asserted-by":"publisher","first-page":"1302","DOI":"10.1093\/jalm\/jfac070","article-title":"2021 patient preferences for point of care testing survey: more acceptance and less concern","volume":"7","author":"Lilly","journal-title":"J Appl Lab Med"},{"issue":"4","key":"R14","doi-asserted-by":"publisher","first-page":"112","DOI":"10.1097\/poc.0000000000000214","article-title":"Patient preferences for point-of-care testing: survey validation and results","volume":"19","author":"Lilly","journal-title":"Point Care"},{"issue":"9","key":"R15","doi-asserted-by":"publisher","first-page":"1665","DOI":"10.1373\/clinchem.2006.084707","article-title":"Improving healthcare accessibility through point-of-care technologies","volume":"53","author":"Price","journal-title":"Clin Chem"},{"issue":"4","key":"R16","doi-asserted-by":"publisher","DOI":"10.3399\/bjgpopen17X101229","article-title":"Point-of-care testing in primary care: needs and attitudes of Irish GPs","volume":"1","author":"Varzgaliene","journal-title":"BJGP Open"},{"key":"R17","doi-asserted-by":"publisher","DOI":"10.3389\/fbioe.2019.00395","article-title":"Technology advancements in blood coagulation measurements for point-of-care diagnostic testing","volume":"7","author":"Mohammadi Aria","journal-title":"Front Bioeng Biotechnol"},{"issue":"7491","key":"R18","doi-asserted-by":"publisher","first-page":"181","DOI":"10.1038\/nature13118","article-title":"The present and future role of microfluidics in biomedical research","volume":"507","author":"Sackmann","journal-title":"Nature New Biol"},{"key":"R19","doi-asserted-by":"publisher","DOI":"10.1016\/j.mne.2019.01.003","article-title":"30 years of microfluidics","volume":"2","author":"Convery","journal-title":"Micro Nano Eng"},{"issue":"1","key":"R20","doi-asserted-by":"publisher","first-page":"467","DOI":"10.1146\/annurev-publhealth-071823-122337","article-title":"Human-centered design to enhance implementation and impact in health","volume":"46","author":"Lyon","journal-title":"Annu Rev Public Health"},{"key":"R21","doi-asserted-by":"publisher","DOI":"10.1016\/j.bios.2025.117469","article-title":"Novel microfluidic device for factor VIII quantification by chemiluminescence in hemophilia A patients","volume":"282","author":"Steeghs","journal-title":"Biosens Bioelectron"},{"issue":"6","key":"R22","doi-asserted-by":"publisher","first-page":"349","DOI":"10.1093\/intqhc\/mzm042","article-title":"Consolidated Criteria for Reporting Qualitative Research (COREQ): a 32-item checklist for interviews and focus groups","volume":"19","author":"Tong","journal-title":"Int J Qual Health Care"},{"key":"R23","doi-asserted-by":"crossref","unstructured":"Kelley JF . An empirical methodology for writing user-friendly natural language computer applications. Presented at: CHI \u201983: Proceedings of the SIGCHI Conference on Human Factors in Computing Systems; Dec 12-15, 1983; Boston, MA. [doi: 10.1145\/800045.801609]","DOI":"10.1145\/800045.801609"},{"key":"R24","unstructured":"Applying human factors and usability engineering to medical devices: guidance for industry and Food and Drug Administration staff. US Food and Drug Administration. Feb 3, 2016. URL: https:\/\/www.fda.gov\/media\/80481\/download [Accessed 07-10-2025]"},{"issue":"3","key":"R25","doi-asserted-by":"publisher","first-page":"202","DOI":"10.1109\/TPC.2010.2052859","article-title":"Assessing concurrent think-aloud protocol as a usability test method: a technical communication approach","volume":"53","author":"Cooke","journal-title":"IEEE Trans Profess Commun"},{"issue":"2","key":"R26","doi-asserted-by":"publisher","first-page":"77","DOI":"10.1191\/1478088706qp063oa","article-title":"Using thematic analysis in psychology","volume":"3","author":"Braun","journal-title":"Qual Res Psychol"},{"issue":"4","key":"R27","doi-asserted-by":"publisher","first-page":"405","DOI":"10.1586\/17434440.2016.1154277","article-title":"Why you need to include human factors in clinical and empirical studies of in vitro point of care devices? Review and future perspectives","volume":"13","author":"Borsci","journal-title":"Expert Rev Med Devices"},{"issue":"1","key":"R28","doi-asserted-by":"publisher","DOI":"10.1186\/1471-2296-14-117","article-title":"Primary care clinicians\u2019 attitudes towards point-of-care blood testing: a systematic review of qualitative studies","volume":"14","author":"Jones","journal-title":"BMC Fam Pract"},{"issue":"1","key":"R29","doi-asserted-by":"publisher","DOI":"10.1186\/s12875-016-0549-1","article-title":"Exploring the barriers and facilitators to use of point of care tests in family medicine clinics in the United States","volume":"17","author":"Hardy","journal-title":"BMC Fam Pract"},{"issue":"1","key":"R30","doi-asserted-by":"publisher","first-page":"1","DOI":"10.3109\/10408363.2015.1054984","article-title":"Barriers to hospital-based clinical adoption of point-of-care testing (POCT): a systematic narrative review","volume":"53","author":"Quinn","journal-title":"Crit Rev Clin Lab Sci"},{"issue":"1","key":"R31","doi-asserted-by":"publisher","first-page":"595","DOI":"10.1182\/asheducation-2017.1.595","article-title":"Using pharmacokinetics to individualize hemophilia therapy","volume":"2017","author":"Iorio","journal-title":"Hematology Am Soc Hematol Educ Program"},{"issue":"7","key":"R32","doi-asserted-by":"publisher","first-page":"785","DOI":"10.1055\/s-0034-1394109","article-title":"Impact of an individualized prophylaxis approach on young adults with severe hemophilia","volume":"40","author":"Fernandes","journal-title":"Semin Thromb Hemost"},{"issue":"3","key":"R33","doi-asserted-by":"publisher","first-page":"468","DOI":"10.1111\/jth.13242","article-title":"Perioperative treatment of hemophilia A patients: blood group O patients are at risk of bleeding complications","volume":"14","author":"Hazendonk","journal-title":"J Thromb Haemost"},{"issue":"4","key":"R34","doi-asserted-by":"publisher","DOI":"10.1136\/bmjopen-2020-042944","article-title":"Qualitative analysis of stakeholder interviews to identify the barriers and facilitators to the adoption of point-of-care diagnostic tests in the UK","volume":"11","author":"Huddy","journal-title":"BMJ Open"},{"key":"R35","doi-asserted-by":"publisher","DOI":"10.1017\/S1463423622000159","article-title":"Roadmap for large-scale implementation of point-of-care testing in primary care in Central and Eastern European countries: the Hungarian experience","volume":"23","author":"D\u00f3zsa","journal-title":"Prim Health Care Res Dev"},{"issue":"11","key":"R36","doi-asserted-by":"publisher","first-page":"1372","DOI":"10.5858\/arpa.2020-0105-RA","article-title":"The benefits and challenges of point-of-care testing in rural and remote primary care settings in Australia","volume":"144","author":"Shephard","journal-title":"Arch Pathol Lab Med"},{"issue":"6","key":"R37","doi-asserted-by":"publisher","first-page":"817","DOI":"10.3233\/THC-140857","article-title":"Exploring risks and benefits of point-of-care tests for healthcare and self-tests for laypersons: an interview study assessing complementary expert perspectives on diagnostic lab-on-a-chip systems","volume":"22","author":"Kuecuekbalaban","journal-title":"Technol Health Care"},{"issue":"2","key":"R38","doi-asserted-by":"publisher","first-page":"123","DOI":"10.1258\/jhsrp.2009.009081","article-title":"Thematic analysis and its reconceptualization as \u201csaliency analysis\u201d","volume":"15","author":"Buetow","journal-title":"J Health Serv Res Policy"},{"key":"R39","unstructured":"User experience design. Semantic Studios. URL: https:\/\/semanticstudios.com\/user_experience_design\/ [Accessed 06-10-2025]"},{"key":"R40","doi-asserted-by":"publisher","DOI":"10.1080\/0142159X.2022.2057287","article-title":"A practical guide to reflexivity in qualitative research: AMEE Guide No. 149","author":"Olmos-Vega","journal-title":"Med Teach"},{"issue":"4","key":"R41","doi-asserted-by":"publisher","first-page":"457","DOI":"10.1177\/001872089203400407","article-title":"Refining the test phase of usability evaluation: how many subjects is enough?","volume":"34","author":"Virzi","journal-title":"Hum Factors"},{"key":"R42","doi-asserted-by":"crossref","unstructured":"Nielsen J Landauer TK . A mathematical model of the finding of usability problems. Presented at: INTERCHI93: Conference on Human Factors in Computing; Apr 24-29, 1993; Amsterdam, The Netherlands. [doi: 10.1145\/169059.169166]","DOI":"10.1145\/169059.169166"},{"issue":"3","key":"R43","doi-asserted-by":"publisher","first-page":"379","DOI":"10.3758\/bf03195514","article-title":"Beyond the five-user assumption: benefits of increased sample sizes in usability testing","volume":"35","author":"Faulkner","journal-title":"Behav Res Methods Instrum Comput"},{"issue":"5","key":"R44","doi-asserted-by":"publisher","first-page":"513","DOI":"10.1586\/17434440.2014.940312","article-title":"How many testers are needed to assure the usability of medical devices?","volume":"11","author":"Borsci","journal-title":"Expert Rev Med Devices"},{"issue":"2","key":"R45","doi-asserted-by":"publisher","first-page":"201","DOI":"10.1080\/2159676X.2019.1704846","article-title":"To saturate or not to saturate? Questioning data saturation as a useful concept for thematic analysis and sample-size rationales","volume":"13","author":"Braun","journal-title":"Qualitative Res Sport Exerc Health"},{"issue":"1","key":"R46","doi-asserted-by":"publisher","first-page":"40","DOI":"10.1111\/medu.13124","article-title":"Shedding the cobra effect: problematising thematic emergence, triangulation, saturation and member checking","volume":"51","author":"Varpio","journal-title":"Med Educ"}],"container-title":["JMIR Formative Research"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/formative.jmir.org\/2025\/1\/e77621","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2026,6,30]],"date-time":"2026-06-30T18:09:52Z","timestamp":1782842992000},"score":1,"resource":{"primary":{"URL":"https:\/\/formative.jmir.org\/2025\/1\/e77621"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2025,10,16]]},"references-count":46,"URL":"https:\/\/doi.org\/10.2196\/77621","relation":{},"ISSN":["2561-326X"],"issn-type":[{"value":"2561-326X","type":"electronic"}],"subject":[],"published":{"date-parts":[[2025,10,16]]},"article-number":"v9i4e77621"}}