An exploration of usability issues in telecare monitoring systems and possible solutions: a systematic literature review

Figures & data

Figure 1. PRISMA flow diagram [32].

Table 1. Context and search query.

Context	String
Telemonitoring	(telemonitoring OR “telemonitoring system” OR tele-monitoring OR “tele monitoring”) AND
Application	(apps or software or device(s) or application(s) or service(s)) AND
Usability	(usability OR understandability OR learnability OR “user experience” OR operability OR attractiveness) AND
Disease	(disease OR care OR patients OR elderly OR illness)

Table 2. Criteria for assessing the quality of the selected studies.

No. Questions	Answer
QAS1: Does the study mention a usability evaluation method?	Yes (+1) / No (+0)
QAS2: Does the study specify usability issues?	Yes (+1) / No (+0)
QAS3: Does the study specify solutions to usability issues?	Yes (+1) / No (+0)
QAS4: Does the study specify the name of telemonitoring services, software or devices?	Yes (+1) / No (+0)
QAS5: Does the study specify the disease for which the telecare monitoring service was used?	Yes (+1) / No (+0)
QAS6: Does the selected study appear in a reputablepublication?	Study with impact factor (+2), study without impact factor but with social science citation indexed (+1), conference (+0.5), other (+0)

Table 3. Publication source of selected studies.

Type of study	Reference	Name of conference/ journal	Research domain	QAS1	QAS2	QAS3	QAS4	QAS5	QAS6	Score
Journal	[39]	International Journal of Medical Informatics	Informatics	1	1	1	1	1	2	7
	[40]	Informatics for Health and Social Care	Informatics	1	1	1	1	1	2	7
	[41]	Applied Clinical Informatics	Informatics	1	1	1	1	1	2	7
	[42]	Journal of Clinical Nursing	Nursing	1	1	1	1	1	2	7
	[43]	Journal of Nursing Management	Nursing	1	1	1	1	1	2	7
	[44]	International Journal of Technology Assessment in Health Care	Technology	1	1	1	1	1	2	7
	[45]	Disability and Rehabilitation: Assistive Technology	Technology	1	1	1	0	1	1	5
	[46]	Patient Preference and Adherence	Technology	1	1	1	1	1	2	5
	[47]	Journal of Telemedicine and Telecare	Technology	1	0	1	1	1	2	6
	[48]	Health Expectations	Health	1	1	1	1	1	2	7
Conference	[49]	IEEE Transactions on Affective Computing	Technology	1	1	1	1	1	0.5	5.5
	[50]	IEEE Transactions on Biomedical Engineering	Technology	1	1	1	1	1	0.5	5.5
	[51]	Engineering in Medicine and Biology Society (EMBC), Annual International Conference of the IEEE	Health	1	1	1	1	1	0.5	5.5
	[52]	Information Technology Applications in Biomedicine, IEEE	Technology	1	0	1	0	1	0.5	3.5
	[53]	International Conference on Bioinformatics and Biomedical Engineering, Springer	Informatics	1	0	1	0	1	0.5	3.5

Figure 2. Frequency of publication.

Table 4. Data extracted for RQ3.

Ref	ISO 9126-1				ISO 9241-11
	Understandability	Learnability	Attractiveness	Operability	Efficiency	Satisfaction	Effectiveness
[49]	no	no	yes	yes	no	no	no
[50]	yes	no	yes	yes	yes	no	no
[51]	yes	no	no	no	yes	no	no
[52]	no	no	no	no	no	yes	yes
[39]	no	no	no	no	no	no	no
[42]	yes	no	yes	yes	no	no	no
[43]	yes	no	no	no	yes	yes	no
[48]	yes	no	yes	no	no	no	no
[46]	yes	no	yes	no	yes	yes	yes
[40]	yes	yes	yes	no	yes	yes	yes
[41]	yes	no	no	no	no	no	no
[53]	no	yes	no	no	no	no	no
[44]	no	no	no	no	no	yes	no
[45]	no	no	no	no	no	yes	no
[47]	yes	no	no	no	no	yes	no

Table 5. Data extracted from RQ4 and RQ5.

Ref	Evaluation method	Duration of the study	Tasks	Users	Health condition
[49]	Pilot study	Three-month	yes	Fifteen patients and medical staff	Heart failure
[50]	Survey	–	yes	Elderly people over 58	Chronic disease
[51]	Study describing the placement and development test outcome from nine volunteers through the CAALYX application	Four weeks	yes	Nine volunteers	Comorbidity
[52]	System modeling approach and case study	–	yes	_	Cystic fibrosis
[39]	Heuristic evaluation	Three to four weeks	yes	Five experts	Chronic obstructive pulmonary disease
[42]	Survey	–	yes	Real users of the system	Chronic disease
[43]	Survey	Six months	yes	Professionals and patients	Chronic obstructive pulmonary disease
[48]	Interview	Eight weeks	yes	Thirteen older participants, three spouses and one carer	Rehabilitation patients
[46]	Think-aloud protocol	Six months	yes	Four participants	Dementia
[40]	Iterative user-centered design methodology	Six-month field trial	yes	Twenty-five elderly users	Chronic obstructive pulmonary disease
[41]	System was assessed in the course of a clinical pilot test and user satisfaction was assessed by usability questionnaire	One week	yes	Twenty-one patients	Heart failure
[53]	Presented a mobile wearable monitoring system and highlighted the key features in simplifying tele-rehabilitation devices	_	_	_	Rehabilitation
[44]	Survey	Fifteen minutes (system used)	yes	Medical experts (n = 34), technical users (n = 39), control group/ participants (n = 44)	Heart failure
[45]	Interviews and development of telecare system	_	_	21 participants	Elderly
[47]	Feasibility study	Six months	_	34 participants (10 males and 24 females)	Elderly

Table 6. Telecare monitoring systems supporting patients with different issues.

		Issues
Studies	Systems	Chronic diseases	Heart problems	Comorbidity	Rehabilitation patients	Dementia	Cystic fibrosis
[49]	Smartphone	✓
[50]	Wireless sensor networks for patient monitoring, alarm	✓
[51]	eCAALYX system			✓
[52]	Web-based monitoring system						✓
[39]	Telekit internet-based monitoring and treatment system	✓
[42]	Home telecare contacts	✓
[43]	Daily monitoring of patient’s condition via the local call center with an integrated community response service	✓
[48]	iPads for videoconferencing and electronic FitBitR devices				✓
[46]	iVitality and iVitality Smartphone application					✓
[40]	AMICA mobile application	✓
[41]	Sensing device that allows the concurrent acquisition of blood pressure and ECG		✓
[44]	Heart patient monitoring system		✓
[47]	Home telehealth system that monitors blood pressure and body weight					✓

Table 7. Types of participants and their evaluations.

	Usability issues identified by the evaluators
Usability evaluators	Difficulty in using system	Lack of user-friendliness	Lack of assistance/help feature	Lack of performance	System not meeting needs	Technical errors	Total studies
Patients	[40,42,43,46,48]	[40,42,43, 46, 49,50]	[48]		[43, 45]	[41, 44]	16
Medical staff		[49]				[44]	2
Volunteers	[51]			[51]			2
Experts	[39]		[39]		[43]	[44]	4
Study authors	[55]						1
Carers	[48]		[48]				2

Table 8. Usability solutions discussed in the selected studies.

Usability issues	Possible solutions for usability issues
Difficulty in using the system	Decrease complexity [42] Provide education and training on use [30,43,47,55] Increase user involvement in the design process [56] Provide clear instructions and tailored technological developments (such as adjustable stands and high-visibility controls) [48]
Lack of user-friendliness	Decrease complexity [42] Include easy-to-use features in the system [55] Design and develop a custom-made user interface [50] Develop a system that is understandable and only consists of necessary functionalities [51]
Lack of an assistance/help feature	Design and develop self-explanatory systems [41] Design and develop a graphical user interface with guidance [53]
Lack of performance	Design and develop a robust system [41]
Failure of system to meet requirements	Consider user feedback [49] Carry out usability evaluations to fulfill users’ requirements [46] Involve users in all phases of development and design[40] Include key users such as doctors and medical care personnel in the development of telemedical applications [44] Create links between users and other stakeholders at the earliest stages of design and development [45]
Technical errors	Heuristic evaluation of the system [39] Properly test the system [39]

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