User-Centered Design and Evaluation of a Web-Based Decision Aid for Older Adults Living With Mild Cognitive Impairment and Their Health Care Providers: Mixed Methods Study

Abstract

Background Mild cognitive impairment (MCI) is often considered a transitional state between normal and pathologic (eg, dementia) cognitive aging. Although its prognosis varies largely, the diagnosis carries the risk of causing uncertainty and overtreatment of older adults with MCI who may never progress to dementia. Decision aids help people become better informed and more involved in decision making by providing evidence-based information about options and possible outcomes and by assisting them in clarifying their personal values in relation to the decision to be made. Objective This study aimed to incorporate features that best support values clarification and adjust the level of detail of a web-based decision aid for individuals with MCI. Methods We conducted a rapid review to identify options to maintain or improve cognitive functions in individuals with MCI. The evidence was structured into a novel web-based decision aid designed in collaboration with digital specialists and graphic designers. Qualitative and user-centered evaluations were used to draw on users’ knowledge, clarify values, and inform potential adoption in routine clinical practice. We invited clinicians, older adults with MCI, and their caregivers to evaluate the decision aid in 6 consecutive rounds, with new participants in each round. Quantitative data were collected using the Values Clarity and Informed subscales of the Decisional Conflict Scale, the System Usability Scale, the Ottawa Acceptability questionnaire, and a 5-point satisfaction rating scale. We verified their comprehension using a teach-back method and recorded usability issues. We recorded the audio and computer screen during the session. An inductive thematic qualitative analysis approach was used to identify and describe the issues that arose. After each round, an expert panel met to prioritize and find solutions to mitigate the issues. An integrated analysis was conducted to confirm our choices. Results A total of 7 clinicians (social workers, nurses, family physicians, psychologists) and 12 older (≥60 years) community-dwelling individuals with MCI, half of them women, with education levels going from none to university diploma, were recruited and completed testing. The thematic analysis revealed 3 major issues. First, the user should be guided through the decision-making process by tailoring the presentation of options to users’ priorities using the values clarification exercise. Second, its content should be simple, but not simplistic, notably by using information layering, plain language, and pictograms. Third, the interface should be intuitive and user friendly, utilize pop-up windows and information tips, avoid drop-down menus, and limit the need to scroll down. The quantitative assessments corroborated the qualitative findings. Conclusions This project resulted in a promising web-based decision aid that can support decision making for MCI intervention, based on the personal values and preferences of the users. Further ongoing research will allow its implementation to be tested in clinical settings.

Using a Mobile Application for Health Communication to Facilitate a Sense of Coherence: Experiences of Older Persons with Cognitive Impairment

“…The first subtheme, “ability to use the interface”, focused on the difficulties encountered while using the touchscreen, patience of using new technologies, and memory loss. These findings are consistent with those of Bogza et al [ 38 ], who observed that difficulties encountered while navigating technologies resulted in frustration in decision making. Hence, the information presented to persons with CI has to be meaningful, concise, and easy to remember.…”

Methods for Human-Centered eHealth Development: Narrative Scoping Review

“…First, in many studies, authors reflected on possible biases that might arise when using questionnaires to develop eHealth [ 24 , 69 , 80 , 97 , 109 , 115 , 126 , 134 , 138 , 139 , 142 , 146 , 149 ]. Among other things, vulnerable target groups with low literacy skills and no internet access were often hard to include in questionnaires [ 96 ].…”

“…It was suggested that experts on, for example, usability or persuasive design can be included by means of cognitive walkthroughs or heuristic evaluations, whereas users can be involved through think-aloud procedures, guided by scenarios [ 127 ]. Second, authors stated that ideally, multiple methods should be combined to paint a full picture of a prototype’s usability [ 24 , 25 , 64 , 77 , 80 , 118 , 152 ]; for example, qualitative methods such as think-aloud procedures and interviews can be combined. Qualitative approaches can also be combined with quantitative data collected by means of, for example, log data analyses, questionnaire data, or eye tracking [ 127 ].…”

A Technology Training Program to Alleviate Social Isolation and Loneliness Among Homebound Older Adults: A Community Case Study

“…Prior research, as well as our own results, indicate that flexibility in program delivery is a necessary characteristic for successful technology training programs, as they allow for goal-motivated learning and individualization to accommodate participants' needs and abilities ( 31 ). To ensure flexibility and improve suitability and acceptance, programs can incorporate the end user throughout program design and development ( 32 , 33 ).…”