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. 2020 Aug 19;22(8):e17406.
doi: 10.2196/17406.

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

Laura-Mihaela Bogza #  1   2   3 , Cassandra Patry-Lebeau #  2   3 , Elina Farmanova  2   3   4 , Holly O Witteman  1   3 , Jacobi Elliott  5 , Paul Stolee  5 , Carol Hudon  6 , Anik M C Giguere  1   2   3
Affiliations

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

Laura-Mihaela Bogza et al. J Med Internet Res. .

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.

Keywords: aging; decision aid; decision support technique; elderly; mild cognitive impairment.

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Conflict of interest statement

Conflicts of Interest: None declared.

Figures

Figure 1
Figure 1
Navigation through the various sections of the web-based decision box as planned in the first prototype, before user testing.
Figure 2
Figure 2
Navigation through various sections of the web-based decision box as planned after user testing.
Figure 3
Figure 3
Presentation of one of the options in prototype V2. Warning: This is a preliminary version, and the data are not final.
Figure 4
Figure 4
Presentation of one of the options in the final version showing the pop-up format and with an enlargement showing an example of the expanded accordion tabs to learn more about the grading of recommendations assessment, development, and evaluation ratings.
Figure 5
Figure 5
First prototype version of the web-based decision aid, showing the values clarification exercise.
Figure 6
Figure 6
First prototype version of the web-based decision aid, showing the feedback page after the exercise. Warning: This is a preliminary version, and the data are not final.
Figure 7
Figure 7
Final version of the web-based decision aid, showing the feedback page after the exercise.
Figure 8
Figure 8
Final version of the web-based decision aid, showing the values clarification exercise.
See this image and copyright information in PMC

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