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How does the use of 'think aloud' usability testing affect the design of a web-based decision aid? Hearne, Sarah; Lynch, Yvonne; Meggait, Erin; Thast, Lauren Aug 31, 2011

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RSPT?572?August?19,?2011?Sarah?Hearne,?Yvonne?Lynch,?Erin?Meggait,?and?Lauren?Thast?Supervisor:?Linda?Li?Outline???Purpose???Background???Methods? ??Results???Discussion???Conclusion?Purpose??To?determine?how?the?use?of?iterative??think?aloud??usability?testing?can?improve?the?usability?of?a?web?based?decision?aid?Objectives?1.? What?users?paid?attention?to?when?using?the?tool?2.? Changes?made?to?the?tool?during?usability?testing?ANSWER??? Has?been?shown?that?patients?want?unbiased?information?about?treatment?so?they?can?make?an?informed?decision??? Led?to?development?of?the?ANSWER?tool,?a?decision?aid?to?assist?RA?patients?in?deciding?whether?or?not?to?take?methotrexate?? ? ? ? ? ? ? ?(Li?et?al,?2009)?Methotrexate??? Current?treatment?guidelines?involve?the?use?of?DMARDs?within?six?months?of?diagnosis??? MTX?is?the?most?commonly?used?DMARD?for?treatment?of?RA??? Well?established?risk?benefit?profile?but?has?some?serious,?but?rare,?side?effects??? Patients?desire?information?to?assist?with?this?decision?making?process?? ?(Lacaille?et?al,?2005;?Visser?&?Heijde,?2009;?van?Ede?et?al,?1998)?ANSWER??? Based?on?the?educational?entertainment?model,?known?as??edutainment???? Includes?six?animated,?non?threatening?scenarios?in?video?format?that?patients?can?identify?with??? Development?team:?Health?researchers,?computer?animation?experts,?patients?with?RA?Usability?Tes?g??? Usability:?Ease?of?use?and?learnability?of?a?human?made?object???? Important?in?developing?a?computer?based?educational?intervention??? Target?population?uses?tool?and?provides?feedback??? Most?effective?when?performed?throughout?the?development?of?a?tool?or?program??? ? ? ? ?????(Pak?et?al,?2010;?Gustafson?&?Wyatt,?2004)?Think?Aloud?Protocol??? Participants?asked?to?think?aloud?or?verbalize?thoughts?as?they?perform?a?task??? Found?to?be?more?reliable?than?post?test?questionnaires?and?interviews??? Concurrent?think?aloud?protocol?allows?researchers?to:??? Gain?insight?into?decision?making???? Identify?usability?problems??? Obtain?qualitative?data?? ? ? ? ? ?(Currie,?2005;?Kushniruk?et?al,?1997)?Methods:?Par?ipants??? 15?self?selected?individuals??? Recruited?from?Mary?Pack?Arthritis?Centre?&?patient/consumer?groups??? Majority?over?50?y.o.?and?university/college?graduates??? Diagnosed?with?RA??? Referred?for?or?already?taking?MTX?Methods:?Analysis??? Two?hour?session?at?ARC??? Think?aloud??protocol??? Participants?instructed?to?verbalize?thoughts?as?they?used?tool??? Entire?session?recorded?and?transcribed?verbatim??? Session?conducted?by?research?staff ???? Prompted?participants?to?elaborate?when?necessary??? Took?field?notes?Methods:?Analysis?Issue?Identification??? Content?Analysis??? Transcribed?audiotapes??? Field?notes??? Identification??? Excluded?comments?on?what?users?liked,?features?that?did?not?yet?exist,?when?users?supposed?what?others?might?do,?or?where?meaning?was?unclear?Methods:?Analysis???Themes?identified??? Issues?categorized?according?to?emerging?themes??? Themes?revised?an?analysis?progressed??? Categories?within?each?theme?defined??? Category?definitions?revised?as?analysis?progressed??? Group?worked?in?pairs?in?close?proximity?to?maximize?inter?rater?reliability?when?coding?Methods:?Analysis?Change?Identification??? Reviewed:??? Print?outs?of?tool??? Communication?between?tool?collaborators??? Identified:??? Issues?raised?and?changes?made??? Issues?raised?and?changes?not?made?Results:?Themes??? Entertainment?Theme??? The?affability?and?engagement?of?the?tool??? Content?Theme??? The?factual?information?provided?by?the?tool??? User?Interaction?Theme??? The?ease?of?use?of?the?tool?Entertainment?Theme??? Emotional?Involvement??? Emotional?response?elicited?by?the?ANSWER?tool??? Relevance??? The?information?and/or?scenario?is?applicable?to?the?user??? Video?Credibility??? Believability?of?the?story,?context,?and?characters?Content?Theme??? Clarity??? Information?presented?is?easy?to?understand??? Agreement??? Information?is?consistent?with?prior?knowledge?and?beliefs??? Comprehensiveness??? Sufficient?information?is?provided?to?satisfy?the?user?User?Interac?n?Sensory?Appeal?of?Website??Add?a?little?more?colour,?make?it?fun?so?you?actually?feel?like?you?are?eager?to?go?into?this?site"?[Female?participant?3]??As?to?the?colour?and?layout,?I?think?it?needs,?it?s?kind?of?flat?and?uninteresting,?okay????[Female?participant?9]?Sensory?Appeal?of?Video??You?know?what??I?have?three?daughters?and?two?of?them?are?in?high?school?but?they?do?a?lot?of?drawing?on?the?computer.??And?frankly?I?think?you?could?have?better?graphics??[Female?participant?12]?Naviga?n??Yeah,??cause?when?it?says??enter?answer??you?re?kind?of?wondering?like?am?I?supposed?to?answer?something?but?it?doesn?t?really?ask?you?a?question??[Female?participant?11]?User?Control???I?m?a?bit?of?a?research?hound.??I?d?like?some?way?to?check?out?the?citations??[Female?participant?9]?Website?Architecture??Do?you?know?that?you?can?actually?play?a?clip????No,?I?don?t?know.???Ah,?okay,?so?it?wasn?t?very?obvious...???No,?it?wasn?t.??[Researcher?&?Female?Participant?8]?Discussion??? Offers?comprehensive?insight?to?the?refinement?and?development?of?a?web?based?tool?by?systematically?analyzing?data?from?a?number?of?different?sources??? As?opposed?to?outlining?usability?testing?was?conducted??? Highlights?the?importance?of?usability?testing?prior?to?wide?scale?use?in?order?to?ensure?appropriateness?for?a?target?population??? Responding?to?users,?reminder?who?the?user?is,?what?they?re?going?through,?and?what?they?need?Results:?Changes??? Issues?raised?and?changes?made??? Navigation??? Issues?raised?and?changes?not?made??? Emotional?Involvement?Discussion:?Theme?Development??? ?Developed?themes?and?categories?in?response?to?data??? Iterative?nature?ensured?comprehensive?definitions??? Initially?as?a?group??? Subsequently?in?pairs,?in?close?proximity?Discussion:?Think?Aloud??? Offers?insight?to?user?s?thought?process??? High?face?validity??? More?verbalizations?vs.?retrospective?feedback??? Impact?of?this?process??? Mental?overload?decreases?reactivity??? Reactivity?increased?by?environment?and?the?fact?they?re?being?observed?Discussion:?Outstanding?Issues??? Remainders?mostly?under?Entertainment?Theme??? Emotional?response?triggered?by?the?tool?was?very?individual??? User?s?history?and?stage?of?life?affected?the?personal?relevance??? Not?central?to?usability??Limita?ns??? Analysis?of?only?negative?feedback??? Inclusion?of?positive?feedback??? Identifying?changes?from?print?outs?and?communications??? Access?to?digital?copy?of?tool?at?different?stages?of?development?Future?Direc?ns??? Document?positive?and?negative?comments??? Video?of?subjects?completing?task?as?3rd?data?source??? Change?identification:?access?to?digital?tool?at?different?stages?of?development?Conclusion??This?study?intended?to?ascertain?how?usability?testing?affected?the?development?of?a?web?based?decision?aid????This?was?accomplished?by?identifying?issues?raised?and?changes?made?during?usability?testing?Acknowledgements???Dr.?Linda?Li??? Has?worked?closely?with?us?on?this?project,?and?sends?her?regrets?for?not?being?able?to?attend?today???Staff?at?ARC:?Jenny,?Charlene,?Katie?and?others??? For?their?aid?and?hospitality?through?this?project?References??? Currie,?L.?2005.?Evaluation?frameworks?for?nursing?informatics.?International?Journal?of??Medical?Informatics,?74(11?12):908?16??? Gustafson,?D.,?Wyatt,?J.?2004.?Evaluation?of?ehealth?systems?and?services.?BMJ,?328(7449):1150??? Kushniruk,?A.,?Patel,?V.,?&?Cimino,?J.?1997.??Usability?testing?in?medical?informatics:?cognitive?approaches?to?evaluation?of?information?systems?and?user?interfaces.?Proc?AMIA?Annu?Fall?Symp.?1997:?218?222 ???? Lacaille?D,?Anis?AH,?Guh?DP,?Esdaile?JM.?Gaps?in?care?for?rheumatoid?arthritis:?A?population?study.?Arthritis?Rheum?2005?Apr?15;53(2):241?8???? Li?LC,?Adam?P,?Townsend?AF,?Stacey?D,?Lacaille?D,?Cox?S,?McGowan?J,?Tugwell?P,?Sinclair?G,?Ho?K,?Backman?CL.?Improving?healthcare?consumer?effectiveness:?An?animated,?self?serve,?web?based?research?tool?(ANSWER)?for?people?with?early?rheumatoid?arthritis.?BMC?Med?Inform?Decis?Mak?2009?Aug?20;9:40.??References??? Pak,?R.,?Stinson,?A.,?McGrath,?P,?Hodnett,?E.,?Feldman,?B.?Duffy,?C.,?Huber,?A.,?Tucker,?L.,?Hetherington,?R.,?Tse,?S.,?Spiegel,?L.,?Campillo,?S.,?Gill,?N.,?&?White,?M.?2010.??Usability?testing?of?an?online?self?management?program?for?adolescents?with?juvenile?idiopathic?arthritis.?Journal?of?Medical?Internet?Research,?12?(3)??? van?Ede?AE,?Laan?RF,?Blom?HJ,?De?Abreu?RA,?van?de?Putte?LB.?Methotrexate?in?rheumatoid?arthritis:?An?update?with?focus?on?mechanisms?involved?in?toxicity.?Semin?Arthritis?Rheum?1998?Apr;27(5):277?92??? Visser?K,?van?der?Heijde?D.?Optimal?dosage?and?route?of?administration?of?methotrexate?in?rheumatoid?arthritis:?A?systematic?review?of?the?literature.?Ann?Rheum?Dis?2009?Jul;68(7):1094?9?Ques?ns??

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