The Usability of Diabetes MAP: A Web-delivered Intervention for Improving Medication Adherence

Abstract

BackgroundWeb-delivered interventions are a feasible approach to health promotion. However, if a website is poorly designed, difficult to navigate, and has technical bugs, it will not be used as intended. Usability testing prior to evaluating a website’s benefits can identify barriers to user engagement and maximize future use.ObjectiveWe developed a Web-delivered intervention called Diabetes Medication Adherence Promotion (Diabetes MAP) and used a mixed-methods approach to test its usability prior to evaluating its efficacy on medication adherence and glycemic control in a randomized controlled trial.MethodsWe recruited English-speaking adults with type 2 diabetes mellitus (T2DM) from an academic medical center who were prescribed diabetes medications. A trained research assistant administered a baseline survey, collected medical record information, and instructed participants on how to access Diabetes MAP. Participants were asked to use the site independently for 2 weeks and to provide survey and/or focus group feedback on their experience. We analyzed survey data descriptively and qualitative data thematically to identify participants’ favorable and unfavorable experiences, characterize usability concerns, and solicit recommendations for improving Diabetes MAP.ResultsEnrolled participants (N=32) were an average of 51.7 ± 11.8 years old, 66% (21/32) female, 60% (19/32) non-Hispanic White, 88% (28/32) had more than 12 years of education, half had household incomes over $50,000, and 78% (25/32) were privately insured. Average duration of diagnosed diabetes was 7.8 ± 6.3 years, average A1c was 7.4 ± 2.0, and 38% (12/32) were prescribed insulin. Of enrolled participants, 91% (29/32) provided survey and/or focus group feedback about Diabetes MAP. On the survey, participants agreed website information was clear and easy to understand, but in focus groups they reported navigational challenges and difficulty overcoming user errors (eg, entering data in an unspecified format). Participants also reported difficulty accessing the site and, once accessed, using all of its features. Participants recommended improving the site’s user interface to facilitate quick, efficient access to all features and content.ConclusionsAdults with T2DM rated the Diabetes MAP website favorably on surveys, but focus groups gave more in-depth feedback on the user experience (eg, difficulty accessing the site, maximizing all of the site’s features and content, and recovering from errors). Appropriate usability testing methods ensure Web-delivered interventions work as intended and any benefits are not diminished by usability challenges.

A Patient-Facing Diabetes Dashboard Embedded in a Patient Web Portal: Design Sprint and Usability Testing

“…Although some usability studies employ a large number of participants, this is mostly done to provide sufficient sample size for quantitative analyses, and additional participants yield relatively few new usability concerns [ 40 - 42 ]. In addition, our usability findings build upon other recent studies of patient-facing diabetes health apps [ 50 , 53 , 59 ]. Georgsson et al used a similar mixed-methods approach to evaluate the usability of their mHealth system for diabetes type 2 self-management [ 53 ].…”

“…Several prior studies have reported the design and usability of patient-facing health apps and Web-based interventions for patients with diabetes [ 50 , 53 - 58 ]. Approaches to the design of these health apps and Web-based interventions typically employ some variation of user-centered design [ 56 - 59 ].…”

“…Deidentified transcripts were imported into NVivo 10 (version 10; QSR International, Burlington, VT) for coding and analysis. Similar to other health app usability studies [ 47 , 50 ], we used selective coding to capture participants’ comments about usability concerns [ 51 ]. Participant comments were sorted into categories that addressed 3 elements of usability: design, efficiency of use, and content and terminology [ 52 ].…”

Patterns of User Engagement with Mobile- and Web-Delivered Self-Care Interventions for Adults with T2DM: A Review of the Literature

“…If working with a low-income population, for example, adopting a low-cost technology (e.g., basic cell phone technology: text messaging and voice communications) and/or providing a stipend to cover costs may improve engagement [20]. Additionally, conducting usability studies can help identify and address technical issues that may discourage engagement in a longer trial [44]. …”

Developing a Shared Patient-Centered, Web-Based Medication Platform for Type 2 Diabetes Patients and Their Health Care Providers: Qualitative Study on User Requirements

“…The review concluded that further research is necessary to improve the design, content, and features from a patient perspective [ 25 ]. To date, only a few studies [ 14 , 26 , 27 ] have reported user requirements regarding the design and development of patient-centered HIT to support T2DM patients in self-managing their medications [ 28 ]. Requirements reported in these studies included reliable information on medication side effects and interactions, electronic messaging, selectively disclosing information, refill reminder functionality, and a user-friendly format [ 14 , 26 , 27 ].…”