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. 2025 Jan 22:12:e65022.
doi: 10.2196/65022.

A User-Centered Design Approach for a Screening App for People With Cognitive Impairment (digiDEM-SCREEN): Development and Usability Study

Michael Zeiler #  1 , Nikolas Dietzel #  2 , Fabian Haug  3   4 , Julian Haug  3   4 , Klaus Kammerer  3 , Rüdiger Pryss  3   4 , Peter Heuschmann  3   4   5 , Elmar Graessel  6 , Peter L Kolominsky-Rabas  2 , Hans-Ulrich Prokosch  1
Affiliations

A User-Centered Design Approach for a Screening App for People With Cognitive Impairment (digiDEM-SCREEN): Development and Usability Study

Michael Zeiler et al. JMIR Hum Factors. .

Abstract

Background: Dementia is a widespread syndrome that currently affects more than 55 million people worldwide. Digital screening instruments are one way to increase diagnosis rates. Developing an app for older adults presents several challenges, both technical and social. In order to make the app user-friendly, feedback from potential future end users is crucial during this development process.

Objective: This study aimed to establish a user-centered design process for the development of digiDEM-SCREEN, a user-friendly app to support early identification of persons with slight symptoms of dementia.

Methods: This research used qualitative and quantitative methods and involved 3 key stakeholder groups: the digiDEM research team, the software development team, and the target user group (older adults ≥65 years with and without cognitive impairments). The development of the screening app was based on an already existing and scientifically analyzed screening test (Self-Administered Tasks Uncovering Risk of Neurodegeneration; SATURN). An initial prototype was developed based on the recommendations for mobile health apps and the teams' experiences. The prototype was tested in several iterations by various end users and continuously improved. The app's usability was evaluated using the System Usability Scale (SUS), and verbal feedback by the end users was obtained using the think-aloud method.

Results: The translation process during test development took linguistic and cultural aspects into account. The texts were also adapted to the German-speaking context. Additional instructions were developed and supplemented. The test was administered using different randomization options to minimize learning effects. digiDEM-SCREEN was developed as a tablet and smartphone app. In the first focus group discussion, the developers identified and corrected the most significant criticism in the next version. Based on the iterative improvement process, only minor issues needed to be addressed after the final focus group discussion. The SUS score increased with each version (score of 72.5 for V1 vs 82.4 for V2), while the verbal feedback from end users also improved.

Conclusions: The development of digiDEM-SCREEN serves as an excellent example of the importance of involving experts and potential end users in the design and development process of health apps. Close collaboration with end users leads to products that not only meet current standards but also address the actual needs and expectations of users. This is also a crucial step toward promoting broader adoption of such digital tools. This research highlights the significance of a user-centered design approach, allowing content, text, and design to be optimally tailored to the needs of the target audience. From these findings, it can be concluded that future projects in the field of health apps would also benefit from a similar approach.

Keywords: aging; cognitive disorder; cognitive impairment; dementia; design; development; digiDEM; feedback; mHealth; mobile app; mobile health; older adults; screening; usability; user centred; user-centered.

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Conflict of interest statement

Conflicts of Interest: RP is a partner in Lenox UG, a company focused on applying scientific findings in digital health applications. Lenox UG holds shares in HealthStudyClub GmbH. This company is responsible for developing the app presented in the paper. RP received consultancy fees, reimbursements for conference attendance, and travel expenses in connection with the topics of mobile health and e-mental health. KK is also a shareholder in HealthStudyClub GmbH and has joined the company as chief technical developer. FH and JH work as freelancers for HealthStudyClub GmbH.

Figures

Figure 1.
Figure 1.. Word selection task as visible on a smartphone.
Figure 2.
Figure 2.. Trail Making Test as visible on a tablet.
Figure 3.
Figure 3.. Illustration of the prototype (V1).
Figure 4.
Figure 4.. Final visualization (V4).
See this image and copyright information in PMC

References

    1. Global status report on the public health response to dementia. World Health Organization. 2021. [15-06-2024]. https://www.who.int/publications/i/item/9789240033245 URL. Accessed.
    1. Eichler T, Thyrian JR, Hertel J, et al. Rates of formal diagnosis of dementia in primary care: the effect of screening. Alzheimers Dement (Amst) 2015 Mar;1(1):87–93. doi: 10.1016/j.dadm.2014.11.007. doi. Medline. - DOI - PMC - PubMed
    1. Wolff F, Dietzel N, Karrer L, et al. Timely diagnosis of dementia: results of the Bavarian Dementia Survey (BayDem) Gesundheitswesen. 2020 Jan;82(1):23–29. doi: 10.1055/a-1031-9559. doi. Medline. - DOI - PubMed
    1. Barth J, Nickel F, Kolominsky-Rabas PL. Diagnosis of cognitive decline and dementia in rural areas - a scoping review. Int J Geriatr Psychiatry. 2018 Mar;33(3):459–474. doi: 10.1002/gps.4841. doi. Medline. - DOI - PubMed
    1. Labrique A, Vasudevan L, Mehl G, Rosskam E, Hyder AA. Digital health and health systems of the future. Glob Health Sci Pract. 2018 Oct 10;6(Suppl 1):S1–S4. doi: 10.9745/GHSP-D-18-00342. doi. Medline. - DOI - PMC - PubMed

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