eHealth Living & Learning Lab Amsterdam, Department of Medical Informatics, Amsterdam UMC, location University of Amsterdam, Amsterdam, Netherlands.
Amsterdam Public Health, Digital Health, Amsterdam, Netherlands.
JMIR Hum Factors. 2024 Jul 31;11:e54032. doi: 10.2196/54032.
Dementia-related impairments can cause complex barriers to access, use, and adopt digital health technologies (DHTs). These barriers can contribute to digital health inequities. Therefore, literature-based design principles called DEMIGNED have been developed to support the design and evaluation of DHTs for this rapidly increasing population.
This study aims to apply the DEMIGNED principles in usability evaluation methods to (1) capture usability problems on a mobile website providing information resources for people visiting a memory clinic, including those living with subjective cognitive decline (SCD), mild cognitive impairment (MCI), or dementia, and (2) investigate the realness of usability problems captured by the DEMIGNED principles in expert testing, specifically for mobile websites that act as a means of providing DHTs.
First, a heuristic evaluation was conducted, with the DEMIGNED principles serving as domain-specific guidelines, with 3 double experts (experienced in both usability and dementia) and 2 usability engineering experts. Second, think-aloud sessions were conducted with patients visiting a memory clinic who were living with SCD, MCI, or dementia.
The heuristic evaluation resulted in 36 unique usability problems. A representative sample of 7 people visiting a memory clinic participated in a think-aloud session, including 4 (57%) with SCD, 1 (14%) with MCI, and 2 (29%) with dementia. The analysis of the think-aloud sessions revealed 181 encounters with usability problems. Of these encounters, 144 (79.6%) could be mapped to 18 usability problems identified in the heuristic evaluation. The remaining 37 (20.4%) encounters from the user testing revealed another 10 unique usability problems. Usability problems frequently described in the think-aloud sessions encompassed difficulties with using the search function, discrepancies between the user's expectations and the content organization, the need for scrolling, information overload, and unclear system feedback.
By applying the DEMIGNED principles in expert testing, evaluators were able to capture 79.6% (144/181) of all usability problem encounters in the user testing of a mobile website for people visiting a memory clinic, including people living with dementia. Regarding unique usability problems, 50% (18/36) of the unique usability problems identified during the heuristic evaluation were captured by the user-testing sessions. Future research should look into the applicability of the DEMIGNED principles to other digital health functionalities to increase the accessibility of digital health and decrease digital health inequity for this complex and rapidly increasing population.
与痴呆症相关的障碍会导致在获取、使用和采用数字健康技术（DHT）方面出现复杂的障碍。这些障碍可能导致数字健康方面的不平等。因此，已经开发了基于文献的设计原则，称为 DEMIGNED，以支持针对这一快速增长的人群的 DHT 的设计和评估。
本研究旨在将 DEMIGNED 原则应用于可用性评估方法，以（1）捕捉移动网站上为访问记忆诊所的人们提供信息资源时出现的可用性问题，包括那些患有主观认知下降（SCD）、轻度认知障碍（MCI）或痴呆症的人，以及（2）调查专家测试中捕获的可用性问题的真实性，特别是针对作为提供 DHT 手段的移动网站。
首先，进行了启发式评估，使用 DEMIGNED 原则作为特定于领域的指南，由 3 名双重专家（在可用性和痴呆症方面均有经验）和 2 名可用性工程专家进行评估。其次，对在记忆诊所就诊的患有 SCD、MCI 或痴呆症的患者进行了出声思维测试。
启发式评估产生了 36 个独特的可用性问题。有代表性的 7 名就诊于记忆诊所的患者参加了出声思维测试，其中 4 名（57%）患有 SCD，1 名（14%）患有 MCI，2 名（29%）患有痴呆症。对出声思维测试的分析显示，共遇到 181 次可用性问题。在这些遇到的问题中，有 144 个（79.6%）可以映射到启发式评估中确定的 18 个可用性问题。用户测试中剩下的 37 个（20.4%）遇到的问题又揭示了另外 10 个独特的可用性问题。在出声思维测试中经常描述的可用性问题包括使用搜索功能的困难、用户的期望与内容组织之间的差异、滚动的需求、信息过载和系统反馈不明确。
通过在专家测试中应用 DEMIGNED 原则，评估人员能够在对记忆诊所访客的移动网站的用户测试中捕获 79.6%（181/181）的所有可用性问题，包括患有痴呆症的人。关于独特的可用性问题，启发式评估中确定的 36 个独特可用性问题中有 18 个（50%）是通过用户测试会议捕获的。未来的研究应该研究 DEMIGNED 原则在其他数字健康功能中的适用性，以提高这一复杂且快速增长人群的数字健康可及性，并减少数字健康不平等。
