A structured framework to improve usability in EHR implementation: a user-centered case study in Brazilian mental healthcare Fernanda Peron Gaspary, Daniel Baia Amaral, Cristian Vinicius Fagundes, Luis Felipe Dias Lopes, João Francisco Pollo Gaspary Frontiers in Digital Health, 2026 Background Electronic Health Record (EHR) systems are central to digital health transformation, yet usability challenges continue to constrain their effectiveness, particularly in mental healthcare contexts. Objectives To develop and describe a structured, user-centered framework for improving EHR usability based on a Brazilian outpatient mental health case study. Methods This qualitative design research study, guided by the Double Diamond design methodology, followed four iterative phases (Discover, Define, Develop, Deliver) and conducted qualitative interviews with 21 healthcare professionals. Data were organized using the Certainties, Suppositions, and Doubts (CSD) matrix and triangulated through heuristic evaluation and prototype testing. Results Key barriers included non-standardized navigation flows, limited integration with external systems, and inflexible documentation structures. Based on these findings, the study proposes design-driven improvements such as customizable templates, real-time validation features, and workflow-specific interface adjustments. Conclusions By integrating service design logic with usability-driven interface adaptations and addressing both systemic usability gaps and contextual demands, this research contributes actionable insights for advancing human-centered EHR innovation, with particular relevance to complex mental healthcare workflows.
Validation of the reduced version of the Brazilian Scale of Moral Distress in Nurses Jordana Lopes Carvalho, Luis Felipe Dias Lopes, Flavia Regina Souza Ramos, Graziele de Lima Dalmolin Revista Latino Americana De Enfermagem, 2025 Objective: to validate a model of the reduced version of the Brazilian Scale of Moral Distress in Nurses. Method: methodological study, with a sample of 269 nurses from a public university hospital in southern Brazil. A sociodemographic questionnaire and the Brazilian Moral Distress Scale for Nurses were used. Descriptive statistics, structural equation modeling, and invariance analysis between age groups were used. Results: regarding profile, professionals aged between 31 and 40, women, married, and specialists prevailed. The structural model fitted the data with acceptable fit indices. The proposed model showed excellent internal consistency, convergent validity, and discriminant validity. The analysis of the structural model revealed that the five hypotheses were confirmed, and the invariance between the age groups indicates that the way the variables are conceptualized, measured, and interrelated in the model does not affect the results, regardless of the groups compared. Conclusion: the scale achieved satisfactory psychometric indicators, proving to be suitable for use, maintaining the relevant validation elements per dimension, and offering practical advantages. Further research is suggested to deepen our understanding of the consequences of moral distress and to develop effective strategies for managing it.
Mediating effects of market orientation on the relationship between market environmental uncertainty and adaptive capacity Maíra Nunes Piveta, Nathália Rigui Trindade, Flavia Luciane Scherer, Soraya de Souza Soares, Luis Felipe Dias Lopes RAE Revista De Administracao De Empresas, 2025 RESUMO Este estudo investiga os efeitos da orientação para o mercado e da incerteza ambiental de mercado na capacidade adaptativa de empresas de base tecnológica instaladas em habitats de inovação. Metodologicamente, a pesquisa incluiu um levantamento com 137 empresas, analisando os dados por meio de modelagem de equações estruturais. Os resultados revelam que a orientação para o mercado, caracterizada por um foco intensivo no cliente, valorização da informação e coordenação interfuncional, eleva significativamente a capacidade adaptativa das organizações. A incerteza ambiental de mercado, definida pela imprevisibilidade das demandas do consumidor, demonstrou uma correlação positiva tanto com a orientação para o mercado quanto com a capacidade adaptativa das empresas. Este estudo enriquece a literatura ao ilustrar que a orientação para o mercado pode atuar como mediadora na interação entre a incerteza ambiental de mercado e a capacidade adaptativa, sugerindo que as organizações podem utilizar sua orientação para o mercado como uma estratégia defensiva e ofensiva.
Barriers to innovation in Brazilian small- and medium-sized enterprises Deoclécio Junior Cardoso da Silva, Guilherme Paraol de Matos, Artur Roberto de Oliveira Gibbon, Claudimar Pereira da Veiga, Clarissa Stefani Teixeira, et al. Journal of Small Business and Enterprise Development, 2025 PurposeThis research investigates the barriers impeding innovation within small- and medium-sized enterprises (SMEs) in Brazil, exploring 54 innovation-related barriers categorized into six distinct groups to offer substantial insights and analyses pertinent to the decision-makers, researchers and SMEs.Design/methodology/approachThis research employed a mixed quantitative and exploratory approach, utilizing fuzzy Delphi, fuzzy analytic hierarchy process (AHP) and fuzzy decision-making trial and evaluation laboratory (DEMATEL) methods. The fuzzy Delphi method confirmed the categories and barriers through quantitative analysis, the fuzzy AHP ranked the validated obstacles and the fuzzy DEMATEL method identified causal connections among the top-priority barriers.FindingsOut of 54 barriers, 23 significantly impacted SMEs. The “Financing and Financial” category was the most significant barrier, with “Access to Financing” being the most critical impediment. The barrier with the most influence was “Instability of Fiscal Policies,” and the highest causal priority was “Survival of the Priority Business,” identifying the government’s unstable fiscal policy as the principal barrier confronting SMEs in Brazil.Originality/valueThe primary challenges for Brazilian SMEs center on financing, fiscal policies and maintaining ongoing operations. By addressing these barriers and fostering a resilient business environment, SMEs’ innovation capabilities and competitiveness can be enhanced, serving as key drivers for sustainable economic growth in fluctuating economic conditions. This study contributes to the literature by highlighting and validating the main barriers to SME innovation, providing highly relevant information about the innovation process.
