Challenges and recommendations for eHealth usability evaluation with elderly users: systematic review and case study

Abstract

Previous research has shown that there are a variety of eHealth usability evaluation methods suitable for agile, easily applicable, and useful eHealth usability evaluations. However, it is unclear whether such eHealth usability evaluation methods are also applicable with elderly users. This study aims to examine the challenges in applying eHealth usability evaluation methods with elderly users and how these challenges can be overcome. We chose three established eHealth usability evaluation methods to evaluate an eHealth intervention: (1) Co-Discovery Evaluation, (2) Cooperative Usability Testing, and (3) Remote User Testing combined with Think Aloud. The case study was conducted with seven Austrian elderly users. We supplemented the case study (March, 2021) with a systematic review (March, 2022) to identify (1) applied eHealth usability evaluation methods to elderly and (2) challenges of eHealth usability evaluations with elderly. Our results showed that Remote User Testing combined with Think Aloud could successfully be applied to evaluate the eHealth intervention with elderly users. However, Cooperative Usability Testing and Co-Discovery Evaluation were not suitable. The results of the systematic review showed that user-based eHealth usability evaluation methods are mostly applied to conduct eHealth usability evaluations with elderly users. Overall, the results showed that not all established eHealth usability evaluation methods are applicable with elderly users. Based on the case study and the systematic review, we developed 24 recommendations on how to deal with challenges during eHealth usability evaluations. The recommendations contribute to improving the accessibility, acceptability, and usability of eHealth interventions by the elderly.

Home-Based Cognitive Intervention for Healthy Older Adults Through Asking Robots Questions: Randomized Controlled Trial

“…This is because users may want to discontinue use of the program before becoming accustomed to it. From this perspective, we need to continue improving usability and developing appropriate evaluation methods, keeping in mind that our target population is older adults [ 39 ]. For example, it would be helpful to investigate which individuals, among those who use less frequently digital devices at baseline, are more likely to experience higher intervention effectiveness.…”

Agile eHealth Usability Evaluation: A Triangulative Approach to Promoting the Usability of eHealth Systems

“…Triangulative research design: research methods applied (presented in steps 1 to 6), in relation to the research phases (phases 1 to 4). The present study is based on three publications that deal with the research design of research phase 1 [13,14], research phase 2 [14], and research phases 3 as well as 4 [15].…”

“…Step 5 -Explorative case study: The aim of the explorative case study was to examine whether an agile eHealth usability evaluation can be conducted with older persons (n=7) who met the inclusion criteria. The inclusion criteria comprised criteria such as an age of at least 60 years, a basic computer literacy, and an e-mail account [15]. The older participants were selected regardless of their socioeconomic status.…”

“…Step 6 -Systematic literature review II: The review considered 300 scientific papers that report on the use of eHealth usability evaluation methods with older persons [15]. The titles and abstracts of the papers were systematically reviewed.…”

“…Step 4 -Context-based selection of appropriate eHealth usability evaluation methods to implement the case study: To accomplish the explorative case study three eHealth usability evaluation methods were chosen from ToUsE [15]. Co-discovery evaluation was selected to give older persons the opportunity to complete tasks together.…”