Department of Urology, Indiana University School of Medicine, Indianapolis, IN, USA; Department of Pediatrics: Center for Pediatric and Adolescent Comparative Effectiveness Research Indianapolis, IN, USA.
Department of Urology, Indiana University School of Medicine, Indianapolis, IN, USA.
J Pediatr Urol. 2020 Oct;16(5):685.e1-685.e8. doi: 10.1016/j.jpurol.2020.08.006. Epub 2020 Aug 19.
Based on our previous qualitative work, we created a web-based decision aid (DA) prototype to facilitate shared decision-making regarding hypospadias.
The objective of this study was to obtain rapid feedback on the prototype as part of an iterative, human-centered design process.
We conducted this study at a statewide, pediatric educational conference in May 2019, recruiting attendees by verbal/written announcements. The DA consisted of: hypospadias overview and surgery "storyboard," frequently asked questions, parent testimonials, and a values clarification exercise. Participants viewed the DA on a tablet as they participated in semi-structured, qualitative interviews covering website acceptability, usability, and preference for surgical photographs versus illustrations. Three coders used qualitative content analysis to identify themes and resolved disagreements by consensus.
Of 295 conference attendees, all 50 who approached us agreed to participate. Responses from 49 participants were available for analysis: 67% female, ages 20-69, 65% Caucasian, 55% MDs. 96% of participants thought the website design matched its purpose; 59.1% preferred surgical illustrations, 8.2% preferred photos, 30.6% preferred both and 2.0% did not like either. Participants recommended improvements in: a) usability/accessibility (e.g. site navigation, visual layout, page length), b) content coverage (e.g. epidemiology, consequences of no/delayed surgery, lifelong risks), c) parent-centeredness (e.g. reading level/writing style) and d) implementation (provider tools, printable handouts). The Extended Summary Figure shows a revised image of the first step of a hypospadias repair based on feedback about participants' preferences for illustrations rather than photographs.
The main strength of our study was the valuable feedback we obtained to inform critical revisions of the DA prototype. We also demonstrated the feasibility and efficacy of a conducting a usability evaluation of a web-based DA in a medical conference setting. One limitation of this study is that the relatively small population sampled limits generalizability and our findings may not reflect the views of all providers who care for hypospadias patients.
The vast majority of providers thought that the design of the Hypospadias Homepage matched its purpose and most preferred surgical illustrations rather than photos to demonstrate the steps of hypospadias surgery. Based on their feedback, we plan to focus our efforts in the following areas: 1) improvement of navigation/menus, 2) reduction in the amount of text per page, 3) expansion of specific content coverage and 4) inclusion of "parent-friendly" visuals such as infographics to represent quantitative data and colorful illustrations to depict hypospadias and its surgical repair.
基于我们之前的定性研究，我们创建了一个基于网络的决策辅助工具（DA）原型，以促进有关尿道下裂的共同决策。
本研究的目的是在迭代的以人为中心的设计过程中获得对原型的快速反馈。
我们于 2019 年 5 月在全州性的儿科教育会议上进行了这项研究，通过口头/书面公告招募与会者。该 DA 包括：尿道下裂概述和手术“故事板”，常见问题解答，家长证言和价值观澄清练习。参与者在平板电脑上观看 DA 的同时，参加了半结构化的定性访谈，涵盖了网站的可接受性，可用性以及对手术照片与插图的偏好。三名编码员使用定性内容分析来识别主题，并通过共识解决分歧。
在 295 名会议与会者中，所有与我们联系的 50 人均同意参加。可分析来自 49 名参与者的响应：女性占 67％，年龄 20-69 岁，白种人占 65％，医生占 55％。96％的参与者认为网站设计与其目的相符；59.1％的人更喜欢手术插图，8.2％的人更喜欢照片，30.6％的人更喜欢两者，而 2.0％的人不喜欢两者。参与者建议改进以下方面：a）可用性/可访问性（例如，网站导航，视觉布局，页面长度）；b）内容涵盖范围（例如，流行病学，不进行手术或延迟手术的后果，终身风险）；c）以父母为中心（例如，阅读水平/写作风格）；d）实施（提供者工具，可打印讲义）。扩展摘要图显示了基于参与者对插图而不是照片的偏好，对尿道下裂修复第一步的修改后的图像。
我们研究的主要优势是获得了有价值的反馈信息，为 DA 原型的关键修订提供了信息。我们还展示了在医学会议环境中对基于网络的 DA 进行可用性评估的可行性和有效性。这项研究的一个局限性是，抽样的相对较小的人群限制了普遍性，并且我们的发现可能无法反映所有治疗尿道下裂患者的提供者的观点。
绝大多数提供者认为 Hypospadias Homepage 的设计与其目的相符，并且大多数人更喜欢手术插图而不是照片来演示尿道下裂手术的步骤。根据他们的反馈，我们计划在以下方面集中精力：1）改善导航/菜单；2）减少每页的文本量；3）扩大特定内容的覆盖范围；4）包括“家长友好”的视觉效果，例如信息图来表示定量数据和丰富多彩的插图来描绘尿道下裂及其手术修复。
