Usability, Acceptability, and Safety Analysis of a Computer-Tailored Web-Based Exercise Intervention (ExerciseGuide) for Individuals With Metastatic Prostate Cancer: Multi-Methods Laboratory-Based Study

Abstract

Background Digital health interventions such as tailored websites are emerging as valuable tools to provide individualized exercise and behavioral change information for individuals diagnosed with cancer. Objective The aim of this study is to investigate and iteratively refine the acceptability and usability of a web-based exercise intervention (ExerciseGuide) for men with metastatic prostate cancer and determine how well individuals can replicate the video-based exercise prescription. Methods A laboratory-based multi-methods design was used, incorporating questionnaires, think-aloud tests, interviews, and movement screening among 11 men aged 63 to 82 years with metastatic prostate cancer. Overall, 9 participants were undergoing androgen deprivation therapy, and 2 were completing chemotherapy. Data were collected in two waves, with changes made for quality improvement after participant 5. Results The intervention’s usability score was deemed moderate overall but improved after modifications (from 60, SD 2.9 to 69.6, SD 2.2 out of 100). Overall, the participants found the intervention acceptable, with scores improving from wave 1 (24.2, SD 1.1 out of 30) to wave 2 (26.3, SD 2.1 out of 30). The personalized multimodal exercise prescription and computer-tailored education were seen as valuable. After wave 1, website navigation videos were added, medical terminology was simplified, and a telehealth component was included after expert real-time telehealth support was requested. Wave 2 changes included the added variety for aerobic exercise modes, reduced computer-tailoring question loads, and improved consistency of style and grammar. Finally, the participants could replicate the resistance exercise videos to a satisfactory level as judged by the movement screen; however, additional technique cueing within the videos is recommended to address safety concerns. Conclusions The acceptability and usability of ExerciseGuide were deemed satisfactory. Various problems were identified and resolved. Notably, the participants requested the inclusion of personalized expert support through telehealth. The resistance training algorithms were shown to provide appropriate content safely, and the users could replicate the exercise technique unaided to a satisfactory level. This study has optimized the ExerciseGuide intervention for further investigation in this population. Trial Registration Australian New Zealand Clinical Trials Registry (ANZCTR) ACTRN12618001978257; https://anzctr.org.au/Trial/Registration/TrialReview.aspx?ACTRN=12618001978257

Acceptability and Preliminary Efficacy of a Web- and Telephone-Based Personalised Exercise Intervention for Individuals with Metastatic Prostate Cancer: The ExerciseGuide Pilot Randomised Controlled Trial

“…Average usability was higher in the tunnelled intervention 67.4 ± 14.6 compared to the free choice intervention 56.4 ± 12.2 [ 63 , 64 ], but as in the current study the score was marginal. Usability testing and iterative refinement was undertaken with ExerciseGuide in a small lab-based study to enhance usability with some success [ 17 ]. However, given, that usability is likely to affect the uptake and continued use of web-based tools additional strategies should be considered, including implementation of feedback from pilot study participants [ 65 ].…”

“…A strength of the study is that the ExerciseGuide intervention was methodically developed based on behavioural theory, previously investigated exercise prescription methodology, and formative user-centred research [ 5 , 8 , 17 ]. Furthermore, the study used a randomised design and publication of the study protocol aimed to ensure transparency around pre-specified criteria for success [ 21 ].…”

“…A randomised controlled pilot trial comprising two study arms, (1) an 8-week exercise intervention arm (web-based tool and telehealth support) and (2) a wait-list control arm. The study protocol, including criteria for progression to a larger definitive trial, was published a priori [ 17 ]. Assessments are completed at baseline and in week nine.…”

“…7 Confidence of not falling within the next 12 months was scored on a scale of one (not true for me) to five (very true for me). 8 Habit formation consisted of four items which were from one (strongly disagree) to five (strongly agree) and the habit formation sum is the summation of all four item scores (ranging from [5][6][7][8][9][10][11][12][13][14][15][16][17][18][19][20]. * Indicates significant values (p < 0.05).…”

“…Compared to individuals with localised disease, individuals with metastatic prostate cancer often have bone lesions and other considerations for exercise prescription, which increase the need for tailored programming to reduce risks. The lab-based evidence of computer-tailored exercise prescription shows encouraging acceptability, usability and safety levels in individuals with metastatic prostate cancer; however, feasibility, safety and efficacy in a real-world setting is currently unknown [ 17 ].…”