Usability testing of a mobile health application to support individuals with active tuberculosis: a mixed methods study

ABSTRACT

Poor adherence to tuberculosis (TB) treatment leads to further disease transmission, worsened outcomes, and the development of drug resistance. Digital adherence technologies may facilitate a more patient-centered approach for improving TB treatment outcomes than current strategies. The objective of this study was to evaluate and explore improving usability of the TB Treatment Support Tools (TB-TST) mobile application. We used an iterative convergent mixed-method design consisting of two quantitative surveys and a qualitative think-aloud interview. Testing was conducted in three testing cycles consisting of a total of 16 interviews and 26 surveys. Results were thematically analyzed and reported to the development team during weekly team meetings. Participants rated the TB-TSTs application as having high usability and the iterative approach resulted in several refinements to the application in response to participant feedback. These refinements were well received during qualitative interviews but did not result in a statistically significant improvement in usability testing scores between cycles. Using an iterative convergent mixed-method design was an effective method for refining our mHealth application. Data collected from think-aloud interviews, the MAUQ, and the Health-ITUES identified key areas of application design that needed refinement.

KEYWORDS:

• Usability testing
• mobile health
• digital adherence technologies
• tuberculosis
• medication adherence

Acknowledgments

This study is funded by the United States National Institute of Health, National Institute of Allergy, and Infectious Disease (R01AI147129: Iribarren, Rubinstein) and is building off development research funded by the National Institute of Nursing Research (K23NR017210: Iribarren). The content is solely the responsibility of the authors and does not represent the official views of the National Institute of Health. We acknowledge the support of students within the University of Washington Human-Centered Design and Engineering for app refinement efforts. We would like to thank Kyle Goodwin for his work programming the TB-TST, Alfie Aguilar Vidrio for his work directing the design of the TB-TST, and Harini Gopal for her contributions to usability testing.

Disclosure statement

No potential conflict of interest was reported by the author(s).

Contributions

SI, JS, and AS contributed to the design of the research. AS collected and analyzed the data. AS was the lead author of the manuscript. SI, JS, GD, and RS contributed to the writing of the manuscript. All authors read and approved the final manuscript.

Additional information

Funding

The work was supported by the National Institute of Nursing Research [K23NR017210]; National Institute of Allergy and Infectious Disease [R01AI147129].