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Employing a user-centered cognitive walkthrough to evaluate a mHealth diabetes self-management application: A case study and beginning method validation
Blekinge Institute of Technology, Faculty of Computing, Department of Creative Technologies.ORCID iD: 0000-0002-9854-7690
University of Utah, USA.
University Hospital of North Norway, NOR.
University of Victoria, CAN.
2019 (English)In: Journal of Biomedical Informatics, ISSN 1532-0464, E-ISSN 1532-0480, Vol. 91, article id 103110Article in journal (Refereed) Published
Abstract [en]

Introduction: Self-management of chronic diseases using mobile health (mHealth) systems and applications is becoming common. Current evaluation methods such as formal usability testing can be very costly and time-consuming; others may be more efficient but lack a user focus. We propose an enhanced cognitive walkthrough (CW) method, the user-centered CW (UC-CW), to address identified deficiencies in the original technique and perform a beginning validation with think aloud protocol (TA) to assess its effectiveness, efficiency and user acceptance in a case study with diabetes patient users on a mHealth self-management application. Materials and methods: A total of 12 diabetes patients at University of Utah Health, USA, were divided into UC-CW and think aloud (TA) groups. The UC-CW method included: making the user the main evaluator for detecting usability problems, having a dual domain facilitator, and using three other improved processes: validated task development, higher level tasks and a streamlined evaluation process. Users interacted with the same mHealth application for both methods. Post-evaluation assessments included the NASA RTLX instrument and a set of brief interview questions. Results: Participants had similar demographic characteristics. A total of 26 usability problems were identified with the UC-CW and 20 with TA. Both methods produced similar ratings: severity across all views (UC-CW = 2.7 and TA = 2.6), numbers of problems in the same views (Main View [UC-CW = 11, TA = 10], Carbohydrate Entry View [UC-CW = 4, TA = 3] and List View [UC-CW = 3, TA = 3]) with similar heuristic violations (Match Between the System and Real World [UC-CW = 19, TA = 16], Consistency and Standards [UC-CW = 17, TA = 15], and Recognition Rather than Recall [UC-CW = 13, TA = 10]). Both methods converged on eight usability problems, but the UC-CW group detected five critical issues while the TA group identified two. The UC-CW group identified needed personalized features for patients’ disease needs not identified with TA. UC-CW was more efficient on average time per identified usability problem and on the total evaluation process with patients. NASA RTLX scores indicated that participants experienced the UC-CW half as cognitively demanding. Common themes from interviews indicated the UC-CW as enjoyable and easy to perform while TA was considered somewhat awkward and more cognitively challenging. Conclusions: UC-CW was effective for finding severe, recurring usability problems and it highlighted the need for personalized user features. The method was also efficient and had high user acceptance. These results indicate UC-CW's utility and user acceptance in evaluating a mHealth self-management application. It provides an additional usability evaluation technique for researchers. © 2019

Place, publisher, year, edition, pages
Elsevier, 2019. Vol. 91, article id 103110
Keywords [en]
Cognitive walkthrough, Diabetes, Mobile health, Think aloud, Usability, User-centered design, Human computer interaction, Medical problems, mHealth, NASA, Usability engineering, User centered design, Demographic characteristics, Diabetes self-management, Mobile Health (M-Health), Think-aloud protocol, Usability evaluation technique, Heuristic methods
National Category
Computer Sciences Human Computer Interaction Endocrinology and Diabetes
Identifiers
URN: urn:nbn:se:bth-15830DOI: 10.1016/j.jbi.2019.103110ISI: 000525688200008Scopus ID: 2-s2.0-85061136199OAI: oai:DiVA.org:bth-15830DiVA, id: diva2:1177979
Note

Uppdaterad från manuskript till artikel i tidskrift vid publicering

Available from: 2018-01-26 Created: 2018-01-26 Last updated: 2023-02-16Bibliographically approved
In thesis
1. Toward Patient-centered, Standardized, and Reproducible Approaches of Evaluating the Usability of mHealth Chronic Disease Self-management Systems for Diabetes
Open this publication in new window or tab >>Toward Patient-centered, Standardized, and Reproducible Approaches of Evaluating the Usability of mHealth Chronic Disease Self-management Systems for Diabetes
2018 (English)Doctoral thesis, comprehensive summary (Other academic)
Abstract [en]

Diabetes is a chronic disease affecting 422 million patients worldwide according to World Health Organization data with 30.3 million in the United States and 64 million in Europe. The prevalence speaks to the need for improved ways to support patients in disease self-management. mHealth solutions are increasingly used for this; however, usability is a current challenge affecting patients’ mHealth use. Recent literature emphasizes an increased focus on patient-centeredness in diabetes care, user-centeredness in chronic disease mHealth system design and standardized, systematic approaches for usability evaluation. The aim of this thesis and its individual studies was to incorporate these foci into the evaluation of two mobile health self-management systems for diabetes.

Study I used ISO standard 9241-11 to examine the relationship between selected group characteristics of diabetes patients on specific interaction outcomes to quantitatively identify needed system modifications. Study II utilized a multi-method design to assess diabetes patients’ mHealth usage and combined two novel analytic methods to structure and analyze results. Study III used a modified, user-oriented heuristic evaluation (HE) method, validated tasks and in-depth severity factor ratings to identify critical problems from patients’ point of view. By developing and employing a modified, user-centered cognitive walkthrough method (UC-CW), study IV assessed its effectiveness and efficiency in finding relevant usability problems for users as well as patients’ acceptance. The modified CW was validated against the golden-standard user test with Think Aloud.

Study I emphasized the importance of considering user characteristics in mHealth performance as these influenced interaction outcomes. All patients had difficulties with multiple-step tasks. Patients more recently diagnosed were able to perform tasks more successfully, with fewer errors and at faster times and had higher satisfaction scores; similar outcomes to the more experienced users. Educational level did not, however, seem to influence performance. In study II, the usability test with Think-Aloud (TA), in-depth interviews and questionnaires contributed to 19 consolidated issues, and triangulated on 5 critical usability problems for users. The combined analysis methods resulted in structured, categorized descriptions to aid in problem-solving. In Study III, the disease-related, critical information deficiencies found by expert evaluators using the modified, structured method also converged on and highlighted potentially adverse user concerns. Study IV demonstrated that the UC-CW found more critical user problems compared to the user test with TA despite both methods producing similar major average severity ratings and violations of heuristic categories. The modified method was more efficient per detected problem and experienced as less cognitively demanding and with a higher ease of use.

These studies offer different approaches that include patient-centered, efficient and user-acceptable methods and method modifications to detect critical usability issues for users. Importantly, improved mHealth designs for users could mean improvement in interactions, interaction performance, increased adoption, and long-term perhaps even increased adherence to interventions for chronic conditions.

Place, publisher, year, edition, pages
Karlskrona: Blekinge Tekniska Högskola, 2018. p. 165
Series
Blekinge Institute of Technology Doctoral Dissertation Series, ISSN 1653-2090 ; 03
Keywords
Chronic Disease, Diabetes, Mobile Health, mHealth, Self-management, Usability Evaluation, User-centered Design
National Category
Computer Sciences
Identifiers
urn:nbn:se:bth-15140 (URN)978-91-7295-349-9 (ISBN)
Public defence
2018-02-23, J1650, BTH, Valhallavägen 1, 37179, Karlskrona, 09:30 (Swedish)
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Supervisors
Note

Tillämpad Hälsoteknik

Applied Health Technology

Available from: 2018-01-29 Created: 2018-01-26 Last updated: 2018-04-06Bibliographically approved

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