Usability Testing by Older Adults of a Computer-Mediated Health Communication Program

Abstract

Failure to adhere to an antihypertensive regimen and interactions between antihypertensives and other medicines represent serious health threats to older adults. This study tested the usability of a touch-screen-enabled personal education program (PEP). Findings showed that older adults rated the PEP system usability, system usefulness, and system-use satisfaction at a moderately high level for prototype-1 and at an exceptionally high level for prototype-2. A 201.91% reduction in interface errors and a 31.08% decrease in interface time also were found between the two trials. This participatory usability design was highly successful in tailoring its program interface design to accommodate older users to enhance their health communication and technology use efficacy.

The authors wish to thank Christian Rauh, MS and Yan Li, MS for creating the computer code for the PEP interface and Veronica Segarra, MS and Sheri Peabody, MS, RN for their assistance in coding the usability data. This work was supported by funding from the National Heart, Lung and Blood Institute, grant number 5R01HL084208, P.J. Neafsey, Principal Investigator.

Notes

¹Guidelines issued by the National Institute on Aging and National Library of Medicine.

²A parallel usability study (Lin, Neafsey, & Anderson, in press) also was conducted with advanced practice registered nurses (APRNs). The provider-tailored PEP system enables the APRN to record blood pressure, age, gender, and prescribed medications. This data entry serves as the baseline for the APRN to evaluate the data entered by the older adults on the PEP system, which is printed and reviewed by the APRN prior to the clinical visit, and to help facilitate patient–provider communication for better care.

³The tablet PC (Motion LE 1600 Centrino) was manufactured by Motion Computing, Inc., in 2006. Technical specifications for this model include: Intel Pentium® M Processor LV 778 (1.6 GHz), Integrated Intel PRO Wireless 2915ABG, 512MB RAM, 30GB HDD with View Anywhere Display, 12.1” wide view XGA TFT display, convertible keyboard, 3-M privacy filter, and Genuine Windows® XP.

⁴The “short portable mental status questionnaire” treats 6–7 correct answers out of 10 as reflective of “mild cognitive impairment” and 8–10 correct answers out of 10 as “normal mental functioning.” The scale adds one point if the patient has 6 or fewer years of education and subtracts one point if the patient has education beyond high school. Source: Pfeiffer, E. (1975). A short portable mental status questionnaire for the assessment of organic brain deficit in elderly patients. Journal of American Geriatrics Society, 23, 433–442.

⁵The “instrumental activities of daily living scale” was used to gauge independent living ability. Source: Lawton, M. P., & Brody, E. M. (1969). Assessment of older people: Self-maintainingand instrumental activities of daily living. Gerontologist, 9, 179–186.

⁶The “rapid estimate of adult literacy in medicine” measures adults' ability to read common medical works and lay terms for body parts and illnesses. Source: Davis, T. C., Crouch, M. A., & Long, S. W. et al. (1991). Rapid assessment literacy levels in adult primary care patients. Family Medicine, 23, 433–435.

^a t value calculated based on equal variance assumed between groups.

^a t value calculated based on equal variance assumed between groups.

^a t values calculated based on equal variance assumed between groups.

⁷“Did you take something for—in the last month?” is asked with respect to the following problems: blood pressure, blood thinning, pain, cold or sinus, allergies, sleep, stomach problems such as indigestion or gas, and low thyroid. “Did you take something for___in the last month?” was asked with respect to calcium pills, vitamins, minerals, herbs or supplements, and alcohol, wine, or liquor.

⁸Following a 3-month clinical trial beta test in 2006, the PEP is currently being implemented in a clinical trial with a sample of 250 patients in 10 primary care practice sites. The aims of the clinical trial are to assess potential increases in learning and self-efficacy in older adults using the program, and to measure behavioral outcomes related to improved adherence to blood pressure medications and avoidance of adverse self-medication behaviors over 3 months' time.