Usability evaluation and adaptation of the e-health Personal Patient Profile-Prostate decision aid for Spanish-speaking Latino men

Abstract

Background: The Personal Patient Profile-Prostate (P3P), a web-based decision aid, was demonstrated to reduce decisional conflict in English-speaking men with localized prostate cancer early after initial diagnosis. The purpose of this study was to explore and enhance usability and cultural appropriateness of a Spanish P3P by Latino men with a diagnosis of prostate cancer.

Methods: P3P was translated to Spanish and back-translated by three native Spanish-speaking translators working independently. Spanish-speaking Latino men with a diagnosis of localized prostate cancer, who had made treatment decisions in the past 24 months, were recruited from two urban clinical care sites. Individual cognitive interviews were conducted by two bilingual research assistants as each participant used the Spanish P3P. Notes of user behavior, feedback, and answers to direct questions about comprehension, usability and perceived usefulness were analyzed and categorized.

Results: Seven participants with a range of education levels identified 25 unique usability issues in navigation, content comprehension and completeness, sociocultural appropriateness, and methodology. Revisions were prioritized to refine the usability and cultural and linguistic appropriateness of the decision aid.

Conclusions: Usability issues were discovered that are potential barriers to effective decision support. Successful use of decision aids requires adaptation and testing beyond translation. Our findings led to revisions further refining the usability and linguistic and cultural appropriateness of Spanish P3P.

Fig. 1

Study process and overview of the Personal Patient Profile – Prostate (P3P) web program. (1) A research assistant monitored the sessions, prompted think-aloud feedback, probed responses, and took notes. (2) Participants accessed the program on a touch screen laptop computer. (3) Questions on demographics and personal preferences were served from (4) a platform using a technical stack of Linux, Apache, MySQL, and PHP (LAMP), and participant answers were stored for re-use. (5) Answers were used to build a menu from which participants could access education on topics like understanding statistics, possible outcomes of different treatment modalities, and how to discuss priority issues with their doctors. Educational material was presented via graphs, videos, on-screen text, and nine printable teaching sheets that could be used off-line

Fig. 2

Screenshot: A set of questions on factors influencing the decision was confusing to participants. This question asked, “How much importance or influence might the following factor or issue have in your treatment choice?: Sexual function. No influence, A little influence, Some influence, A lot of influence”

Fig. 3

Screenshot: Multiple questions on one screen were not well understood. These questions asked, “How much of a problem, if any, is each of the following for you?: Urgency to have a bowel movement; Increased frequency of bowel movements; Losing control of your stools; Bloody stools; Abdominal/Pelvic/Rectal pain. No Problem, Very Small Problem, Small Problem, Moderate Problem, Big Problem”

Fig. 4

Screenshots: Three questions requiring keyboard entry of responses presented usability issues. The questions ask, “What year were you born? (Please use 4 digits, for example, 19_ _)”; “Influential factors in your treatment decision: Please touch or click inside of the box, and then type in any additional comments that you may have about your treatment decision.”; and, “Please type in anything else you would like to tell us about getting information. (Touch or click inside the box to begin typing)”