Change search
CiteExportLink to record
Permanent link

Direct link
Cite
Citation style
  • apa
  • ieee
  • modern-language-association-8th-edition
  • vancouver
  • Other style
More styles
Language
  • de-DE
  • en-GB
  • en-US
  • fi-FI
  • nn-NO
  • nn-NB
  • sv-SE
  • Other locale
More languages
Output format
  • html
  • text
  • asciidoc
  • rtf
Toward Patient-centered, Standardized, and Reproducible Approaches of Evaluating the Usability of mHealth Chronic Disease Self-management Systems for Diabetes
Blekinge Institute of Technology, Faculty of Computing, Department of Creative Technologies.ORCID iD: 0000-0002-9854-7690
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 [en]
Chronic Disease, Diabetes, Mobile Health, mHealth, Self-management, Usability Evaluation, User-centered Design
National Category
Computer Sciences
Identifiers
URN: urn:nbn:se:bth-15140ISBN: 978-91-7295-349-9 (print)OAI: oai:DiVA.org:bth-15140DiVA, id: diva2:1178017
Public defence
2018-02-23, J1650, BTH, Valhallavägen 1, 37179, Karlskrona, 09:30 (Swedish)
Opponent
Supervisors
Note

Tillämpad Hälsoteknik

Applied Health Technology

Available from: 2018-01-29 Created: 2018-01-26 Last updated: 2018-04-06Bibliographically approved
List of papers
1. Quantifying usability: an evaluation of a diabetes mHealth system on effectiveness, efficiency, and satisfaction metrics with associated user characteristics
Open this publication in new window or tab >>Quantifying usability: an evaluation of a diabetes mHealth system on effectiveness, efficiency, and satisfaction metrics with associated user characteristics
2016 (English)In: JAMIA Journal of the American Medical Informatics Association, ISSN 1067-5027, E-ISSN 1527-974X, Vol. 23, no 1, p. 5-11Article in journal (Refereed) Published
Abstract [en]

Objective Mobile health (mHealth) systems are becoming more common for chronic disease management, but usability studies are still needed on patients' perspectives and mHealth interaction performance. This deficiency is addressed by our quantitative usability study of a mHealth diabetes system evaluating patients' task performance, satisfaction, and the relationship of these measures to user characteristics. Materials and Methods We used metrics in the International Organization for Standardization (ISO) 9241-11 standard. After standardized training, 10 patients performed representative tasks and were assessed on individual task success, errors, efficiency (time on task), satisfaction (System Usability Scale [SUS]) and user characteristics. Results Tasks of exporting and correcting values proved the most difficult, had the most errors, the lowest task success rates, and consumed the longest times on task. The average SUS satisfaction score was 80.5, indicating good but not excellent system usability. Data trends showed males were more successful in task completion, and younger participants had higher performance scores. Educational level did not influence performance, but a more recent diabetes diagnosis did. Patients with more experience in information technology (IT) also had higher performance rates. Discussion Difficult task performance indicated areas for redesign. Our methods can assist others in identifying areas in need of improvement. Data about user background and IT skills also showed how user characteristics influence performance and can provide future considerations for targeted mHealth designs. Conclusion Using the ISO 9241-11 usability standard, the SUS instrument for satisfaction and measuring user characteristics provided objective measures of patients' experienced usability. These could serve as an exemplar for standardized, quantitative methods for usability studies on mHealth systems.

Place, publisher, year, edition, pages
Oxford University Press, 2016
Keywords
diabetes; mobile health; self-management; usability evaluation; user-centered design
National Category
Endocrinology and Diabetes Other Medical Sciences not elsewhere specified
Identifiers
urn:nbn:se:bth-11378 (URN)10.1093/jamia/ocv099 (DOI)000374179500003 ()
Available from: 2016-01-08 Created: 2016-01-08 Last updated: 2018-01-26Bibliographically approved
2. An evaluation of patients' experienced usability of a diabetes mHealth system using a multi-method approach
Open this publication in new window or tab >>An evaluation of patients' experienced usability of a diabetes mHealth system using a multi-method approach
2016 (English)In: Journal of Biomedical Informatics, ISSN 1532-0464, E-ISSN 1532-0480, Vol. 59, p. 115-129Article in journal (Refereed) Published
Place, publisher, year, edition, pages
Elsevier, 2016
Keywords
Diabetes; Framework analysis; Multi-method evaluation; Usability Problem Taxonomy; mHealth
National Category
Endocrinology and Diabetes
Identifiers
urn:nbn:se:bth-11379 (URN)10.1016/j.jbi.2015.11.008 (DOI)000384703900009 ()
Note

open access

Available from: 2016-01-08 Created: 2016-01-08 Last updated: 2018-01-26Bibliographically approved
3. A Modified User-Oriented Heuristic Evaluation of a Mobile Health System for Diabetes Self-management Support
Open this publication in new window or tab >>A Modified User-Oriented Heuristic Evaluation of a Mobile Health System for Diabetes Self-management Support
2016 (English)In: Computers, Informatics, Nursing, ISSN 1538-2931, E-ISSN 1538-9774, Vol. 34, no 2, p. 77-84Article in journal (Refereed) Published
Abstract [en]

Mobile health platforms offer significant opportunities for improving diabetic self-care, but only if adequate usability exists. Expert evaluations such as heuristic evaluation can provide distinct usability information about systems. The purpose of this study was to complete a usability evaluation of a mobile health system for diabetes patients using a modified heuristic evaluation technique of (1) dual-domain experts (healthcare professionals, usability experts), (2) validated scenarios and user tasks related to patients' self-care, and (3) in-depth severity factor ratings. Experts identified 129 usability problems with 274 heuristic violations for the system. The categories Consistency and Standards dominated at 24.1% (n = 66), followed by Match Between System and Real World at 22.3% (n = 61). Average severity ratings across system views were 2.8 (of 4), with 9.3% (n = 12) rated as catastrophic and 53.5% (n = 69) as major. The large volume of violations with severe ratings indicated clear priorities for redesign. The modified heuristic approach allowed evaluators to identify unique and important issues, including ones related to self-management and patient safety. This article provides a template for one type of expert evaluation adding to the informaticists' toolbox when needing to conduct a fast, resource-efficient and user-oriented heuristic evaluation. 

Place, publisher, year, edition, pages
Lippincott Williams & Wilkins, 2016
Keywords
Diabetes; Heuristic evaluation; Mobile health; Patient self-management; Usability evaluation
National Category
Endocrinology and Diabetes
Identifiers
urn:nbn:se:bth-11380 (URN)10.1097/CIN.0000000000000209 (DOI)000376461500004 ()
Note

Open access

Available from: 2016-01-08 Created: 2016-01-08 Last updated: 2018-01-26Bibliographically approved
4. Employing a user-centered cognitive walkthrough to evaluate a mHealth diabetes self-management application: A case study and beginning method validation
Open this publication in new window or tab >>Employing a user-centered cognitive walkthrough to evaluate a mHealth diabetes self-management application: A case study and beginning method validation
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
Keywords
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:nbn:se:bth-15830 (URN)10.1016/j.jbi.2019.103110 (DOI)000525688200008 ()2-s2.0-85061136199 (Scopus ID)
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

Open Access in DiVA

fulltext(13217 kB)1849 downloads
File information
File name FULLTEXT05.pdfFile size 13217 kBChecksum SHA-512
5efc699c39ea0d0e8cd1bee1738df52d6ff6be8a751abcbb480cd6ace515e9e28d2c9e4c049ad620ec0d0076eb99049be78ef87cf740dfae31fb2b4e32948be7
Type fulltextMimetype application/pdf

Authority records

Georgsson, Mattias

Search in DiVA

By author/editor
Georgsson, Mattias
By organisation
Department of Creative Technologies
Computer Sciences

Search outside of DiVA

GoogleGoogle Scholar
Total: 1947 downloads
The number of downloads is the sum of all downloads of full texts. It may include eg previous versions that are now no longer available

isbn
urn-nbn

Altmetric score

isbn
urn-nbn
Total: 13892 hits
CiteExportLink to record
Permanent link

Direct link
Cite
Citation style
  • apa
  • ieee
  • modern-language-association-8th-edition
  • vancouver
  • Other style
More styles
Language
  • de-DE
  • en-GB
  • en-US
  • fi-FI
  • nn-NO
  • nn-NB
  • sv-SE
  • Other locale
More languages
Output format
  • html
  • text
  • asciidoc
  • rtf