A Handheld Tool for the Rapid Morphological Identification of Mosquito Species (VectorCam) for Community-Based Malaria Vector Surveillance: Summative Usability Study.

BACKGROUND: Malaria impacts nearly 250 million individuals annually. Specifically, Uganda has one of the highest burdens, with 13 million cases and nearly 20,000 deaths. Controlling the spread of malaria relies on vector surveillance, a system where collected mosquitos are analyzed for vector species' density in rural areas to plan interventions accordingly. However, this relies on trained entomologists known as vector control officers (VCOs) who identify species via microscopy. The global shortage of entomologists and this time-intensive process cause significant reporting delays. VectorCam is a low-cost artificial intelligence-based tool that identifies a mosquito's species, sex, and abdomen status with a picture and sends these results electronically from surveillance sites to decision makers, thereby deskilling the process to village health teams (VHTs). OBJECTIVE: This study evaluates the usability of the VectorCam system among VHTs by assessing its efficiency, effectiveness, and satisfaction. METHODS: The VectorCam system has imaging hardware and a phone app designed to identify mosquito species. Two users are needed: (1) an imager to capture images of mosquitos using the app and (2) a loader to load and unload mosquitos from the hardware. Critical success tasks for both roles were identified, which VCOs used to train and certify VHTs. In the first testing phase (phase 1), a VCO and a VHT were paired to assume the role of an imager or a loader. Afterward, they swapped. In phase 2, two VHTs were paired, mimicking real use. The time taken to image each mosquito, critical errors, and System Usability Scale (SUS) scores were recorded for each participant. RESULTS: Overall, 14 male and 6 female VHT members aged 20 to 70 years were recruited, of which 12 (60%) participants had smartphone use experience. The average throughput values for phases 1 and 2 for the imager were 70 (SD 30.3) seconds and 56.1 (SD 22.9) seconds per mosquito, respectively, indicating a decrease in the length of time for imaging a tray of mosquitos. The loader's average throughput values for phases 1 and 2 were 50.0 and 55.7 seconds per mosquito, respectively, indicating a slight increase in time. In terms of effectiveness, the imager had 8% (6/80) critical errors and the loader had 13% (10/80) critical errors in phase 1. In phase 2, the imager (for VHT pairs) had 14% (11/80) critical errors and the loader (for VHT pairs) had 12% (19/160) critical errors. The average SUS score of the system was 70.25, indicating positive usability. A Kruskal-Wallis analysis demonstrated no significant difference in SUS (H value) scores between genders or users with and without smartphone use experience. CONCLUSIONS: VectorCam is a usable system for deskilling the in-field identification of mosquito specimens in rural Uganda. Upcoming design updates will address the concerns of users and observers.

Development and Evaluation of a Web-Based Platform for Personalized Educational and Professional Assistance for Dementia Caregivers: Proposal for a Mixed Methods Study.

BACKGROUND: Alzheimer disease (AD) and AD-related dementia are prevalent concerns for aging populations. With a growing older adult population living in the United States, the number of people living with dementia is expected to grow, posing significant challenges for informal caregivers. The mental and physical burdens associated with caregiving highlight the importance of developing novel and effective resources to support caregivers. However, technology solutions designed to address their needs often face low adoption rates due to usability issues and a lack of contextual relevance. This study focuses on developing a web-based platform providing financial and legal planning information and education for dementia caregivers and evaluating the platform's usability and adoptability. OBJECTIVE: The goal of this project is to create a web-based platform that connects caregivers with personalized and easily accessible resources. This project involves industrial, academic, and community partners and focuses on two primary aims: (1) developing a digital platform using a Dementia Care Personalization Algorithm and assessing feasibility in a pilot group of caregivers, and (2) evaluating the acceptability and usability of the digital platform across different racial or ethnic populations. This work will aid in the development of technology-based interventions to reduce caregiver burden. METHODS: The phase I study follows an iterative Design Thinking approach, involving at least 25 dementia caregivers as a user feedback panel to assess the platform's functionality, aesthetics, information, and overall quality using the adapted Mobile Application Rating Scale. Phase II is a usability study with 300 dementia caregivers in Texas (100 African American, 100 Hispanic or Latinx, and 100 non-Hispanic White). Participants will use the digital platform for about 4 weeks and evaluate its usefulness and ease of use through the Technology Acceptance Survey. RESULTS: The study received funding from the National Institute on Aging on September 3, 2021. Ethical approval for phase I was obtained from the Texas A&M University Institutional Review Board on December 8, 2021, with data collection starting on January 1, 2022, and concluding on May 31, 2022. Phase I results were published on September 5, 2023, and April 17, 2024, respectively. On June 21, 2023, ethical approval for human subjects for phase II was granted, and participant recruitment began on July 1, 2023. CONCLUSIONS: Upon completing these aims, we expect to deliver a widely accessible digital platform tailored to assist dementia caregivers with financial and legal challenges by connecting them to personalized, contextually relevant information and resources in Texas. If successful, we plan to work with caregiving organizations to scale and sustain the platform, addressing the needs of the growing population living with dementia. INTERNATIONAL REGISTERED REPORT IDENTIFIER (IRRID): DERR1-10.2196/64127.

Use of the FallAkte Plus System as an IT Infrastructure for the North Rhine-Westphalian General Practice Research Network: Mixed Methods Usability Study.

BACKGROUND: Primary care research networks can generate important information in the setting where most patients are seen and treated. However, this requires a suitable IT infrastructure (ITI), which the North Rhine-Westphalian general practice research network is looking to implement. OBJECTIVE: This mixed methods research study aims to evaluate (study 1) requirements for an ITI and (study 2) the usability of an IT solution already available on the market, the FallAkte Plus (FA+) system for the North Rhine-Westphalian general practice research network, which comprises 8 primary care university institutes in Germany's largest state. METHODS: In study 1, a survey was conducted among researchers from the institutes to identify the requirements for a suitable ITI. The questionnaire consisted of standardized questions with open-ended responses. In study 2, a mixed method approach combining a think-aloud approach and a quantitative survey was used to evaluate the usability and acceptance of the FA+ system among 3 user groups: researchers, general practitioners, and practice assistants. Respondents were asked to assess the usability with the validated system usability scale and to test a short questionnaire on vaccination management through FA+. RESULTS: In study 1, five of 8 institutes participated in the requirements survey. A total of 32 user requirements related primarily to study management were identified, including data entry, data storage, and user access management. In study 2, a total of 36 participants (24 researchers and 12 general practitioners or practice assistants) were surveyed in the mixed methods study of an already existing IT solution. The tutorial video and handouts explaining how to use the FA+ system were well received. Researchers, unlike practice personnel, were concerned about data security and data protection regarding the system's emergency feature, which enables access to all patient data. The median overall system usability scale rating was 60 (IQR 33.0-85.0), whereby practice personnel (median 82, IQR 58.0-94.0) assigned higher ratings than researchers (median 44, IQR 14.0-61.5). Users appreciated the option to integrate data from practices and other health care facilities. However, they voted against the use of the FA+ system due to a lack of support for various study formats. CONCLUSIONS: Usability assessments vary markedly by professional group and role. In its current stage of development, the FA+ system does not fully meet the requirements for a suitable ITI. Improvements in the user interface, performance, interoperability, security, and advanced features are necessary to make it more effective and user-friendly. Collaborating with end users and incorporating their feedback are crucial for the successful development of any practice network research ITI.

Usability of an Eye Drop Delivery Aid for Single-Dose Instillation: Results from a Market Research Study.

Background: One of the challenges of treating chronic ocular diseases like vernal keratoconjunctivitis (VKC), glaucoma, and ocular surface disease is patient adherence to topical medication. To support correct eye drop instillation, a variety of delivery aids have been developed for both single-dose and conventional multi-dose containers. Methods: To evaluate Dropaid™ Single-dose, an eye drop delivery aid designed for single-dose containers, a usability study was conducted on 30 parents and caregivers of patients with VKC. After assessing the ability to squeeze a single eye drop from the single-dose container onto the eye of a pediatric medical dummy, the delivery aid was evaluated using an 11-point Likert scale on a variety of characteristics: from "very difficult" (-5) to "very easy" (+5). Results: The majority of participants rated the task of opening the single-dose units (SDUs), preparing, and positioning the Dropaid™ Single-dose device as "very easy". When providing a single eye drop from the container, 87% of participants rated the Dropaid™ Single-dose device as either "very easy" or "easy", with a median rating score of +5.0 (interquartile range [IQR], 4.0-5.0). For general ease of use, 84% considered the delivery aid as either "very easy" or "easy", with a median score of +4.0 (IQR, 3.0-5.0). Most participants (93%) rated Dropaid™ Single-dose as either "very comfortable" or "comfortable" to hold, with a median score of +5.0 (IQR, 4.0-5.0). Conclusion: The Dropaid™ Single-dose delivery aid demonstrated rapid learning and ease of use across all stages of application, including opening the container, eye drop administration, and handling comfort. Although designed for use with single-dose containers to help eye drop instillation in patients with VKC, Dropaid™ Single-dose may provide a wider utility across a range of other ocular diseases such as glaucoma and dry eye.

Understanding cancer patient cohorts in virtual reality environment for better clinical decisions: a usability study.

BACKGROUND: Visualising patient genomic data in a cohort with embedding data analytics models can provide relevant and sensible patient comparisons to assist a clinician with treatment decisions. As immersive technology is actively used around the medical world, there is a rising demand for an efficient environment that can effectively display genomic data visualisations on immersive devices such as a Virtual Reality (VR) environment. The VR technology will allow clinicians, biologists, and computer scientists to explore a cohort of individual patients within the 3D environment. However, demonstrating the feasibility of the VR prototype needs domain users' feedback for future user-centred design and a better cognitive model of human-computer interactions. There is limited research work for collecting and integrating domain knowledge into the prototype design. OBJECTIVE: A usability study for the VR prototype--Virtual Reality to Observe Oncology data Models (VROOM) was implemented. VROOM was designed based on a preliminary study among medical users. The goals of this usability study included establishing a baseline of user experience, validating user performance measures, and identifying potential design improvements that are to be addressed to improve efficiency, functionality, and end-user satisfaction. METHODS: The study was conducted with a group of domain users (10 males, 10 females) with portable VR devices and camera equipment. These domain users included medical users such as clinicians and genetic scientists and computing domain users such as bioinformatics and data analysts. Users were asked to complete routine tasks based on a clinical scenario. Sessions were recorded and analysed to identify potential areas for improvement to the data visual analytics projects in the VR environment. The one-hour usability study included learning VR interaction gestures, running visual analytics tool, and collecting before and after feedback. The feedback was analysed with different methods to measure effectiveness. The statistical method Mann-Whitney U test was used to analyse various task performances among the different participant groups, and multiple data visualisations were created to find insights from questionnaire answers. RESULTS: The usability study investigated the feasibility of using VR for genomic data analysis in domain users' daily work. From the feedback, 65% of the participants, especially clinicians (75% of them), indicated that the VR prototype is potentially helpful for domain users' daily work but needed more flexibility, such as allowing them to define their features for machine learning part, adding new patient data, and importing their datasets in a better way. We calculated the engaged time for each task and compared them among different user groups. Computing domain users spent 50% more time exploring the algorithms and datasets than medical domain users. Additionally, the medical domain users engaged in the data visual analytics parts (approximately 20%) longer than the computing domain users.

Gamification to Improve Medication Adherence: A Mixed-method Usability Study for MedScrab.

Medication non-adherence is a prevalent healthcare problem with poor health outcomes and added healthcare costs. MedScrab, a gamification-based mHealth app, is the first attempt to deliver crucial life-saving medication information to patients and increase their medication adherence. The paper presents the development of MedScrab and a two-phase mixed-method usability evaluation of MedScrab. Phase I qualitatively evaluated MedScrab using a think-aloud protocol for its usability. With 51 participants, qualitative data analysis of Phase I revealed two themes: positive functionality of the app and four areas of improvement. The improvement recommendations were incorporated into MedScrab's design. Phase I also validated a widely used mHealth App Usability Questionnaire (MAUQ). Quantitative data analysis of Phase I reduced the original 18-item MAUQ scale to a 15-item scale with two factors: ease of use (4 items) and usefulness and satisfaction (11 items). Phase II surveyed 83 participants from Amazon's Mechanical Turk using a modified MAUQ. The modified MAUQ scale showed strong internal consistency (Cronbach alpha = 0.959) and high factor loadings (between 0.623 and 0.987). The study design of the usability evaluation can serve as a methodological guide for designing, evaluating, and improving mHealth apps.The usability study showed that MedScrab was perceived as ease of use (6.24 out of 7) with high usefulness and satisfaction (5.72 out of 7). The quantitative data analysis results support the use of the modified MAUQ as a valid instrument to measure the usability of the MedScrab. However, the instrument should be used with adaptation based on the app's characteristics.

Digital Health App to Address Disparate HIV Outcomes Among Black Women Living in Metro-Atlanta: Protocol for a Multiphase, Mixed Methods Pilot Feasibility Study.

BACKGROUND: Cisgender Black women in the southern United States are at heightened risk for HIV and adverse sexual and reproductive health outcomes. Mobile health interventions that target HIV risk while being adapted to the needs and lived experiences of Black women are remarkably limited. OBJECTIVE: The study aims to refine SavvyHER, a mobile app for HIV prevention, with Black women residing in high HIV incidence areas of Georgia and evaluate the feasibility, acceptability, and usability of SavvyHER. This paper describes the procedures implemented to conduct this research. METHODS: Community-based participatory research tenets guide this multiphase study to finalize the development of what we hypothesize will be an effective, sustainable, and culturally relevant HIV prevention and optimal sexual health and reproductive wellness app for Black women. This multiphased, mixed methods study consists of 3 phases. The first phase entails focus groups with Black women to understand their preferences for the functionality and design of a beta prototype version of SavvyHER. In the second phase, an app usability pretest (N=10) will be used to refine and optimize the SavvyHER app. The final phase will entail a pilot randomized controlled trial (N=60) to evaluate the app's feasibility and usability in preparation for a larger trial. RESULTS: Findings from preliminary focus groups revealed educational content, app aesthetics, privacy considerations, and marketing preferred by Black women, thus informing the first functional SavvyHER prototype. As we adapt and test the feasibility of SavvyHER, we hypothesize that the app will be an effective, sustainable, and culturally relevant HIV prevention, sexual health, and reproductive wellness tool for Black women. CONCLUSIONS: The findings from this research substantiate the importance of developing health interventions curated for and by Black women to address critical HIV disparities. The knowledge gained from this research can reduce HIV disparities among Black women through a targeted intervention that centers on their health needs and priorities. INTERNATIONAL REGISTERED REPORT IDENTIFIER (IRRID): DERR1-10.2196/42712.

Usability Study of an Electronic Medical Record From the Nurse Practitioners' Practice: A Qualitative Study Using the Think-Aloud Technique.

INTRODUCTION:  Ensuring the usability of electronic medical records (EMRs) is crucial for healthcare providers to offer efficient, effective, and safe patient care. Nurse practitioners (NPs) are integral to the healthcare system and are essential in managing patient workflows. However, few studies assess NPs' perspectives on how EMR usage affects workflow and patient care quality. METHOD: In this study, the "think-aloud technique" was utilized for usability testing. It involves observing users (NPs) as they complete their everyday tasks on the EMR while vocalizing their thoughts and emotions. This method has been proven reliable and valid through various research, such as a systematic review. RESULTS: The EMR system used by NPs can create a heavy cognitive workload, have limited functionality, can lead to unintended errors, and may experience technical difficulties. CONCLUSION: The EMR system used by NPs is challenging due to three main issues: high cognitive workload, limited system functionality, and technical problems. To improve the system, it is recommended to reduce the cognitive burden by customizing the user interface to fit the NPs' needs, enhancing the system's functionality by adding essential features and fixing any technical issues.

Usability testing of an electronic patient-reported outcome system linked to an electronic chemotherapy prescribing and patient management system for patients with cancer.

Background: People affected by cancer experience a wide range of symptoms which have a major impact on their functioning and health-related quality of life (HRQoL). One way to measure the impact of cancer symptoms is through the use of patient-reported outcomes. Methods: An electronic patient-reported outcome (ePRO) application (ChemoPRO®) was designed to be used by cancer patients to report their symptoms and communicate with their clinical team. Usability testing sessions were conducted with people with lived experience of cancer to understand how real users interact with the ChemoPRO® system. One-to-one testing sessions were conducted to assess use of the system and identify areas for further refinement. User satisfaction was assessed using a brief satisfaction questionnaire previously used by Aiyegbusi et al. (date). Results: Ten people with lived experience of cancer took part in the usability study. Symptoms and HRQoL measures, including the Euroqol EQ5D5L and the PRO-CTCAE™ were included in the ePRO system. Participants: had a mean age of 62.3 years. Three critical errors and 21 non-critical errors were reported. All participants were enthusiastic about the app. Participants liked the simplicity and responsiveness of the patient-facing app and highlighted the potential for communicating with their clinical team. The overall usability and satisfaction score was 4.5 (sd = 0.09). Conclusion: This usability study suggests that people with lived experience of cancer found the ChemoPRO® app acceptable and easy to use. One of the key features of this particular ePRO system that should be developed further is system functionality to facilitate communication between patients and clinicians. Future testing should include testing in a clinical setting and testing with people from ethnic minorities.

Democratizing the Development of Chatbots to Improve Public Health: Feasibility Study of COVID-19 Misinformation.

BACKGROUND: Chatbots enable users to have humanlike conversations on various topics and can vary widely in complexity and functionality. An area of research priority in chatbots is democratizing chatbots to all, removing barriers to entry, such as financial ones, to help make chatbots a possibility for the wider global population to improve access to information, help reduce the digital divide between nations, and improve areas of public good (eg, health communication). Chatbots in this space may help create the potential for improved health outcomes, potentially alleviating some of the burdens on health care providers and systems to be the sole voices of outreach to public health. OBJECTIVE: This study explored the feasibility of developing a chatbot using approaches that are accessible in low- and middle-resource settings, such as using technology that is low cost, can be developed by nonprogrammers, and can be deployed over social media platforms to reach the broadest-possible audience without the need for a specialized technical team. METHODS: This study is presented in 2 parts. First, we detailed the design and development of a chatbot, VWise, including the resources used and development considerations for the conversational model. Next, we conducted a case study of 33 participants who engaged in a pilot with our chatbot. We explored the following 3 research questions: (1) Is it feasible to develop and implement a chatbot addressing a public health issue with only minimal resources? (2) What is the participants' experience with using the chatbot? (3) What kinds of measures of engagement are observed from using the chatbot? RESULTS: A high level of engagement with the chatbot was demonstrated by the large number of participants who stayed with the conversation to its natural end (n=17, 52%), requested to see the free online resource, selected to view all information about a given concern, and returned to have a dialogue about a second concern (n=12, 36%). CONCLUSIONS: This study explored the feasibility of and the design and development considerations for a chatbot, VWise. Our early findings from this initial pilot suggest that developing a functioning and low-cost chatbot is feasible, even in low-resource environments. Our results show that low-resource environments can enter the health communication chatbot space using readily available human and technical resources. However, despite these early indicators, many limitations exist in this study and further work with a larger sample size and greater diversity of participants is needed. This study represents early work on a chatbot in its virtual infancy. We hope this study will help provide those who feel chatbot access may be out of reach with a useful guide to enter this space, enabling more democratized access to chatbots for all.

Evaluation of the EsteR Toolkit for COVID-19 Decision Support: Sensitivity Analysis and Usability Study.

BACKGROUND: During the COVID-19 pandemic, local health authorities were responsible for managing and reporting current cases in Germany. Since March 2020, employees had to contain the spread of COVID-19 by monitoring and contacting infected persons as well as tracing their contacts. In the EsteR project, we implemented existing and newly developed statistical models as decision support tools to assist in the work of the local health authorities. OBJECTIVE: The main goal of this study was to validate the EsteR toolkit in two complementary ways: first, investigating the stability of the answers provided by our statistical tools regarding model parameters in the back end and, second, evaluating the usability and applicability of our web application in the front end by test users. METHODS: For model stability assessment, a sensitivity analysis was carried out for all 5 developed statistical models. The default parameters of our models as well as the test ranges of the model parameters were based on a previous literature review on COVID-19 properties. The obtained answers resulting from different parameters were compared using dissimilarity metrics and visualized using contour plots. In addition, the parameter ranges of general model stability were identified. For the usability evaluation of the web application, cognitive walk-throughs and focus group interviews were conducted with 6 containment scouts located at 2 different local health authorities. They were first asked to complete small tasks with the tools and then express their general impressions of the web application. RESULTS: The simulation results showed that some statistical models were more sensitive to changes in their parameters than others. For each of the single-person use cases, we determined an area where the respective model could be rated as stable. In contrast, the results of the group use cases highly depended on the user inputs, and thus, no area of parameters with general model stability could be identified. We have also provided a detailed simulation report of the sensitivity analysis. In the user evaluation, the cognitive walk-throughs and focus group interviews revealed that the user interface needed to be simplified and more information was necessary as guidance. In general, the testers rated the web application as helpful, especially for new employees. CONCLUSIONS: This evaluation study allowed us to refine the EsteR toolkit. Using the sensitivity analysis, we identified suitable model parameters and analyzed how stable the statistical models were in terms of changes in their parameters. Furthermore, the front end of the web application was improved with the results of the conducted cognitive walk-throughs and focus group interviews regarding its user-friendliness.

Development and usability evaluation of an electronic health report form to assess health in young people: a mixed-methods approach.

BACKGROUND: Electronic Patient-Reported Outcomes (ePROs) have potential to improve health outcomes and healthcare. The development of health-technology applications, such as ePROs, should include the potential users and be theoretically grounded. Swedish Youth Health Clinics (YHCs) offer primarily sexual and psychological healthcare for young people aged 12 to 25 years old. Young people in healthcare settings are considered a vulnerable group. The development of a collection of Patient-Reported Outcomes (PROs) in an Electronic Health Report Form (eHRF) for identifying health and health-related problems in young people, was preceded by a qualitative interview study, exploring young people's views on using an eHRF at YHCs and which questions about health an eHRF should contain. The aim of the current study was to develop and evaluate the usability of an eHRF prototype for identifying health and health-related problems in young people visiting YHCs. METHODS: This study used a participatory design. During the development, an expert panel consisting of eight researchers and one Information Technology worker, participated. A wide literature search was performed to find PROs to construct an eHRF prototype to cover health areas. A mixed methods usability evaluation included 14 participants (young people, healthcare professionals, and an expert panel). RESULTS: The development resulted in an eHRF prototype, containing ten reliable and valid health questionnaires addressing mental-, physical-, and sexual health and social support, a self-efficacy question, and background questions, in total 74 items. The interviews in the usability evaluation resulted in three categories describing the usability of the eHRF: 'Captures the overall health of young people but needs clarification', 'Fun, easy, and optional and will keep young people's interest', and 'Potential contribution to improve the health consultation'. The quantitative results support the usability of the eHRF for YHCs. CONCLUSIONS: The participatory approach contributed to development of the eHRF prototype to cover health areas adapted for the target population. The usability evaluation showed that the eHRF was usable and had the potential for self-reflection and contributions to cooperation between young people and healthcare professionals during the health consultation.

The Development of a Hypertension Prevention and Financial-Incentive mHealth Program Using a "No-Code" Mobile App Builder: Development and Usability Study.

BACKGROUND: Regular physical activity (PA) is a key lifestyle component for hypertension prevention. Previous studies have shown that mobile health (mHealth) apps can be an effective tool for improving PA behaviors. However, adherence to and poor engagement with these apps is a challenge. A potential solution to overcome this challenge may be to combine financial incentives with innovative behavior theory, such as the Multiprocess Action Control (M-PAC) framework. Currently, there is a lack of PA financial incentive-driven M-PAC mHealth programs aimed at hypertension prevention. OBJECTIVE: We aimed to describe the process of developing an 8-week mHealth PA and financial-incentive hypertension education program (Healthy Hearts) and to evaluate usability of the Healthy Hearts program. METHODS: The first 2 stages of the Integrate, Design, Assess, and Share framework were used to guide the development of the Healthy Hearts program. The development process consisted of 2 phases. In phase 1, the research team met to discuss implementing the M-PAC framework to adopt an existing web-based hypertension prevention program to a mobile app. The app was developed using a no-code app development platform, Pathverse (Pathverse Inc), to help decrease overall development time. In phase 2, we created a prototype and conducted usability testing to evaluate lesson 1 of the Healthy Hearts program to further enhance the user experience. We used semistructured interviews and the mHealth App Usability Questionnaire to evaluate program acceptability and usability. RESULTS: Intervention development among the research team successfully created an 8-week financial-incentive hypertension education program for adults aged 40-65 years who did not currently meet the Canadian Physical Activity Guidelines (<150 minutes of moderate to vigorous PA per week). This program lasted 8 weeks and comprised 25 lessons guided by the M-PAC framework. The program used various behavior change techniques to further support PA adherence. Usability testing of the first lesson was successful, with 6 participants recruited for 2 rounds of testing. Feedback was gathered to enhance the content, layout, and design of the Healthy Hearts program to prepare the mHealth program for feasibility testing. Results of round 1 of usability testing suggested that the content delivered in the lessons was long. Therefore, the content was divided into multiple lessons before round 2 of usability testing, where feedback was only on design preferences. A minimum viable product was created with these results. CONCLUSIONS: The iterative development process and the usability assessments suggested by the Integrate, Design, Assess, and Share framework enabled participants to provide valuable feedback on the content, design, and layout of the program before advancing to feasibility testing. Furthermore, the use of the "no-code" app development tool enabled our team to rapidly make changes to the app based on user feedback during the iterative design process.

Design of a Patient Voice App Experience for Heart Failure Management: Usability Study.

BACKGROUND: The use of digital therapeutics (DTx) in the prevention and management of medical conditions has increased through the years, with an estimated 44 million people using one as part of their treatment plan in 2021, nearly double the number from the previous year. DTx are commonly accessed through smartphone apps, but offering these treatments through additional platforms can improve the accessibility of these interventions. Voice apps are an emerging technology in the digital health field; not only do they have the potential to improve DTx adherence, but they can also create a better user experience for some user groups. OBJECTIVE: This research aimed to identify the acceptability and feasibility of offering a voice app for a chronic disease self-management program. The objective of this project was to design, develop, and evaluate a voice app of an already-existing smartphone-based heart failure self-management program, Medly, to be used as a case study. METHODS: A voice app version of Medly was designed and developed through a user-centered design process. We conducted a usability study and semistructured interviews with patients with heart failure (N=8) at the Peter Munk Cardiac Clinic in Toronto General Hospital to better understand the user experience. A Medly voice app prototype was built using a software development kit in tandem with a cloud computing platform and was verified and validated before the usability study. Data collection and analysis were guided by a mixed methods triangulation convergence design. RESULTS: Common themes were identified in the results of the usability study, which involved 8 participants with heart failure. Almost all participants (7/8, 88%) were satisfied with the voice app and felt confident using it, although half of the participants (4/8, 50%) were unsure about using it in the future. Six main themes were identified: changes in physical behavior, preference between voice app and smartphone, importance of music during voice app interaction, lack of privacy concerns, desired reassurances during voice app interaction, and helpful aids during voice app interaction. These findings were triangulated with the quantitative data, and it concluded that the main area for improvement was related to the ease of use; design changes were then implemented to better improve the user experience. CONCLUSIONS: This work offered preliminary insight into the acceptability and feasibility of a Medly voice app. Given the recent emergence of voice apps in health care, we believe that this research offered invaluable insight into successfully deploying DTx for chronic disease self-management using this technology.

Internet-Delivered Self-help for Adults With ADHD (MyADHD): Usability Study.

BACKGROUND: Although effective pharmacological treatment exists, many adults with attention-deficit/hyperactivity disorder (ADHD) prefer a nonpharmacological option for managing their symptoms. Internet-delivered self-help interventions have the potential to address this unmet supportive care need reported by adults with ADHD, at relatively low costs. However, if the intervention does not offer optimal functions, content, and layout, it could decrease adherence and engagement and potentially compromise the effectiveness of such interventions. Thus, there is a need for examining the usability and factors that enhance and impair the usability of internet-delivered self-help interventions. OBJECTIVE: This study evaluates the usability of an internet-delivered self-help intervention for adults with ADHD (MyADHD). The main goals were to (1) collect qualitative and quantitative data on usability and (2) identify usability problems. METHODS: Individual think-aloud interviews and staged usability testing (N=5) were conducted to evaluate the usability of the MyADHD intervention in terms of function, content, and design. MyADHD end users provided iterative feedback to maximize engagement and usability. They performed tasks involved in operating the intervention and provided "think-aloud" commentary and postsession usability ratings. The interviews were recorded, transcribed verbatim, and analyzed. RESULTS: Participants were satisfied with the overall usability of the program. The average perceived usability score out of 100 was 70 for the first round of testing and improved to 77.5 after applying modifications, with a mean score of 75.5 (SD 5.9) for all rounds of usability testing. The analysis of the interviews revealed 3 central themes: functionality, content, and layout. CONCLUSIONS: Optimizing the usability of internet-delivered self-guided interventions is a critical step in the design and development process. The usability testing in this study provided valuable information from users' perspectives on the content and platform of the intervention. Analysis revealed the need for intervention enhancement with regard to design, functionality, and content from the perspective of potential end users. Overall, participants saw value in the MyADHD intervention and were confident that they could use it for the self-management of symptoms and expressed the desire to use the entire intervention when it becomes available. Through this development process, we produced an intervention that is likely to be used successfully and is ready for deployment in a randomized controlled trial. TRIAL REGISTRATION: ClinicalTrials.gov NCT04511169; https://clinicaltrials.gov/ct2/show/NCT04511169.

An educator's toolkit for virtual simulation: A usability study.

BACKGROUND: The rapid change brought on by COVID-19 meant that many educators adopted virtual simulation quickly, often without having a strong background in the pedagogical principles of virtual simulation. To address this resource gap, a team of 21 Ontario virtual simulation-experienced educators created the freely available, online, interprofessional Virtual Simulation Educator's Toolkit. The Toolkit provides the theory, practical strategies and resources needed to teach effectively with virtual simulation. Because the Toolkit would include new content, resources and numerous untested design elements, the team conducted a usability test. DESIGN: A usability study, that followed a three-step process, was conducted. Participants were asked to carefully review the Toolkit, including all interactive components and complete an online survey based on the Technology Acceptance Model, to measure the ease of use and utility of the Toolkit. Lastly, participants were interviewed. PARTICIPANTS: In keeping with sampling principles for usability studies, twenty experienced virtual simulation educators from different disciplines participated in the study. METHODS: A validated survey and one-on-one interviews were used to measure educators' perceptions of the ease of use and utility of the Toolkit and their recommendations to improve it. Quantitative data were analyzed using descriptive statistics and qualitative data were coded and themes developed. CONCLUSION: The score of 90 % on the Toolkit Experience Survey indicated that participants found the Toolkit both easy to use and useful. Results from the interviews indicated that a practical, accessible professional development tool is urgently needed to support education with virtual simulation. Because the Toolkit introduces educators to different ways of implementing virtual simulation, as well as options, process considerations, and tools to enhance their teaching with virtual simulation, different disciplines and educators with different levels of simulation experience may benefit by using it.

Usability Study of the iACTwithPain Platform: An Online Acceptance and Commitment Therapy and Compassion-Based Intervention for Chronic Pain.

Background: This pilot study aims to test the usability of the iACTwithPain platform, an online ACT-based intervention for people with chronic pain, to obtain information on which intervention and usability aspects need improvement and on expected retention rates. Methods: Seventy-three Portuguese women with chronic pain were invited to complete the first three sessions of the iACTwithPain intervention assess their quality, usefulness and the platform's usability. Twenty-one accepted the invitation. Additionally, eight healthcare professionals working with chronic medical conditions assessed the platform and the intervention from a practitioner's point of view. Results: This study presented a considerable attrition rate (71.43%) among chronic pain participants, with six completers. There were no significant differences in demographic or clinical variables between dropouts and completers except for completed education (participants who dropped out presented less education than completers). Reasons for dropout were related to difficult personal events occurring during the time of the intervention, lack of time, or having forgotten. There seemed to be an overall satisfaction with both the intervention, its contents and form of presentation of information, and the platform, concerning its design, appearance, and usability. Real image videos were preferred over animations or audio by chronic pain participants. Healthcare professionals emphasized the appealing and dynamic aspects of the animation format. Conclusion: This study informs the ongoing improvement of the iACTwithPain platform and provides valuable information on aspects researchers should consider while developing online psychological interventions for chronic pain. Further implications are discussed.

A Coding Framework for Usability Evaluation of Digital Health Technologies.

Several studies have reported low adherence and high resistance from clinicians to adopt digital health technologies into clinical practice, particularly the use of computer-based clinical decision support systems. Poor usability and lack of integration with the clinical workflow have been identified as primary issues. Few guidelines exist on how to analyze the collected data associated with the usability of digital health technologies. In this study, we aimed to develop a coding framework for the systematic evaluation of users' feedback generated during focus groups and interview sessions with clinicians, underpinned by fundamental usability principles and design components. This codebook also included a coding category to capture the user's clinical role associated with each specific piece of feedback, providing a better understanding of role-specific challenges and perspectives, as well as the level of shared understanding across the multiple clinical roles. Furthermore, a voting system was created to quantitatively inform modifications of the digital system based on usability data. As a use case, we applied this method to an electronic cognitive aid designed to improve coordination and communication in the cardiac operating room, showing that this framework is feasible and useful not only to better understand suboptimal usability aspects, but also to recommend relevant modifications in the design and development of the system from different perspectives, including clinical, technical, and usability teams. The framework described herein may be applied in other highly complex clinical settings, in which digital health systems may play an important role in improving patient care and enhancing patient safety.

Virtual Reality Cardiac Surgical Planning Software (CorFix) for Designing Patient-Specific Vascular Grafts: Development and Pilot Usability Study.

BACKGROUND: Patients with single ventricle heart defects receive 3 stages of operations culminating in the Fontan procedure. During the Fontan procedure, a vascular graft is sutured between the inferior vena cava and pulmonary artery to divert deoxygenated blood flow to the lungs via passive flow. Customizing the graft configuration can maximize the long-term benefits. However, planning patient-specific procedures has several challenges, including the ability for physicians to customize grafts and evaluate their hemodynamic performance. OBJECTIVE: The aim of this study was to develop a virtual reality (VR) Fontan graft modeling and evaluation software for physicians. A user study was performed to achieve 2 additional goals: (1) to evaluate the software when used by medical doctors and engineers, and (2) to explore the impact of viewing hemodynamic simulation results in numerical and graphical formats. METHODS: A total of 5 medical professionals including 4 physicians (1 fourth-year resident, 1 third-year cardiac fellow, 1 pediatric intensivist, and 1 pediatric cardiac surgeon) and 1 biomedical engineer voluntarily participated in the study. The study was pre-scripted to minimize the variability of the interactions between the experimenter and the participants. All participants were trained to use the VR gear and our software, CorFix. Each participant designed 1 bifurcated and 1 tube-shaped Fontan graft for a single patient. A hemodynamic performance evaluation was then completed, allowing the participants to further modify their tube-shaped design. The design time and hemodynamic performance for each graft design were recorded. At the end of the study, all participants were provided surveys to evaluate the usability and learnability of the software and rate the intensity of VR sickness. RESULTS: The average times for creating 1 bifurcated and 1 tube-shaped graft after a single 10-minute training session were 13.40 and 5.49 minutes, respectively, with 3 out 5 bifurcated and 1 out of 5 tube-shaped graft designs being in the benchmark range of hepatic flow distribution. Reviewing hemodynamic performance results and modifying the tube-shaped design took an average time of 2.92 minutes. Participants who modified their tube-shaped graft designs were able to improve the nonphysiologic wall shear stress (WSS) percentage by 7.02%. All tube-shaped graft designs improved the WSS percentage compared to the native surgical case of the patient. None of the designs met the benchmark indexed power loss. CONCLUSIONS: VR graft design software can quickly be taught to physicians with no engineering background or VR experience. Improving the CorFix system could improve performance of the users in customizing and optimizing grafts for patients. With graphical visualization, physicians were able to improve WSS percentage of a tube-shaped graft, lowering the chance of thrombosis. Bifurcated graft designs showed potential strength in better flow split to the lungs, reducing the risk for pulmonary arteriovenous malformations.

Video Game to Attenuate Pandemic-Related Stress From an Equity Lens: Development and Usability Study.

BACKGROUND: The emergence of the novel coronavirus (COVID-19) has introduced additional pressures on an already fragile mental health care system due to a significant rise in depression, anxiety, and stress among Canadians. Although cognitive behavioral therapy (CBT) is known to be an efficacious treatment to reduce such mental health issues, few people have access to CBT in an engaging and sustainable manner. To address this gap, a collaboration between the Centre for Addiction and Mental Health (CAMH) and the National Research Council of Canada (NRC) developed CBT-based self-led, online, clinician-tested modules in the form of a video game, named Legend of Evelys, and evaluated its usability in the attenuation of a COVID-19-related increase in stress. OBJECTIVE: We here present the conceptualization and design of new self-care modules in the form of a video game, its implementation in a technological infrastructure, and inclusivity and privacy considerations that informed the development. A usability study of the modules was performed to assess the video game's usability, user engagement, and user perceptions. METHODS: The development of the video game involved establishment of a technology infrastructure for secure implementation of the software for the modules and a clinician-led assessment of the clinical utility of these modules through two "whiteboard" sessions. The usability study was informed by a mixed methods sequential explanatory design to evaluate the intervention of the mobile app through two distinct phases: quantitative data collection using in-app analytics data and two surveys, followed by qualitative data collection by semistructured interviews. RESULTS: A total of 32 participants trialed the app for 2 weeks. They used the video game an average of six times and rated the game as "good" based on the Systems Usability Scale score. In terms of stress reduction, the study demonstrated a significant difference in the participants' Perceived Stress Scale score at baseline (mean 22.14, SD 6.187) compared with that at the 2-week follow-up (mean 18.04, SD 6.083; t27=3.628, P=.001). Qualitative interviews helped participants identify numerous functionality issues and provided specific recommendations, most of which were successfully integrated into the video game for future release. CONCLUSIONS: Through this collaboration, we have established that it is possible to incorporate CBT exercises into a video game and have these exercises adopted to address stress. While video games are a promising strategy to help people with their stress and anxiety, there is a further need to examine the real-world effectiveness of the Legend of Evelys in reducing anxiety.