1. Design and Usability of an Online Patient Information System Robert Luke, Ph.D. George Brown College, Toronto, Canada Lynda Atack, R.N., Ph.D. Centennial College, Toronto, Canada

2. Acknowledgements Funding provided by Inukshuk Internet, Inc. Partners Centennial College George Brown College Centre for Effective Practice, Department of Family and Community Medicine, University of Toronto Princess Margaret Hospital, Toronto

3. Study background Patients who gain knowledge and skills improve their ability to manage self-care, enhance decision-making and improve their quality of life. (Klein-Fedyshyn, 2005) Patients are becoming increasingly interested in health education to manage their health; however, clinicians have less time and resources to assist with this process Approximately 10 million American adults will access the Internet on any given day for health information, much of that information is inappropriate or incorrect

4. PEPTalk A research project was conducted to develop and conduct usability testing for a health education website: PEPTalk – Personal Education Plans / Patient Education Prescription The PEPTalk website provides accessible clinician vetted, information for patients. Patients receive health education text and video prescribed by clinicians, tailored to meet their individual needs Patients can change the way information is displayed, accommodating for vision, hearing and language.

5. Patient prescription process

7. Usability study design A “think-aloud” usability testing process used in usability lab: Patients worked through set tasks, observed by researchers Interview and satisfaction survey Process and survey developed from a study by Nahm, Preece, Resnick and Mills (2004)

8. “Think-aloud” process Study conducted in a two-room usability lab Patient room: Internet-enabled computer and a microphone Computer equipped with audio recording and mouse-tracking capabilities Observation room has a one-way, observational mirror and a computer for note- taking, audio feed and a monitor that enables researchers to observe participants

9. The Participants (n = 8) Patient diagnoses: -head and neck cancer (n = 2), -diabetes (n = 3) - breast cancer (n = 3). Age range: 40 to 69. 88% percent were female, 63% had English as their first language, 37% indicated otherwise. Participants had a range of computer access and Internet skills

10. Process Same protocol followed with all patients. Patients asked to share their thoughts out loud as they worked through the website. The session was audio-taped and mouse tracking movements were observed and recorded.

11. Data collection and analysis Patients spent about 75 minutes completing the think-aloud website usability testing process Survey administered (PHWSUQ, Nahm et al. 2004) Think-aloud tapes and interviews were transcribed and a content analysis was completed

12. Results: Patient satisfaction Survey Mean score was 86.5/100 Range of scores: 74 to 100/100 Most patients were very satisfied with the PEPTalk website.

13. Survey subscales ‘ease of use’ subscale mean: 84.5/100 however, the minimum score for this subscale was 71/100. The mean for item ‘overall appearance of the site’: 5.5 (out of 7) ‘ease of finding specific information’: 5.6 ‘it was easy to learn this website’: 5.7 Mean for usefulness subscale: 92.8/100 Mean for item, ‘This website will help me improve my knowledge about health’: 6.7

14. Interview results: a need for PEPTalk 6/8 participants remarked that the information from their own previous Internet searches was frequently: - overwhelming - contradictory - confusing - out of date.

15. Impact of illness on health information needs One patient likened the experience of being diagnosed with cancer to visiting a foreign country: “I tell you it’s a place that I’ve never been, and I wish I hadn’t gone, but I’m there and I need all the help I can get.”

16. PEPTalk as an ongoing resource Some patients had to learn complex self-care procedures such as bandaging to prevent lymphedema, managing g-tube feeds and learning new exercise protocols. The ability to view these procedures on video as often as needed was seen as a very significant benefit of PEPTalk.

17. Confidence in health information Information on PEPTalk was generated by nurses, physicians, dieticians, physiotherapists and others One patient noted, “that gives it a stamp of approval”

18. Design recommendations The home page is key and should: Convey information about the purpose and value of the PEPTalk site Have visual appeal. One patient commented, “You need something that’s going to talk to you, something that makes you want to find out what’s inside.” Establish the credibility of site information Give information about site security

19. Design recommendations Keep information concise, simple, non-technical: “When hit with something monumental like cancer, less is often better” Keep technical options simple. Most could not understand the options being offered and missed the key change most wanted to make: to increasing font size of text Keep content in modular form, presented on one page or less.

20. Conclusion Positive results likely because patients are anxious for reliable health information and, Worked through the testing with researchers present User-friendly, appealing design and establishing credibility and security are essential We highly recommend the multi-method usability testing process More design work and research ahead!

21. Demonstration We’ll now walk you through the PEPTalk website …..

22. Contact us Robert Luke rluke@georgebrown.ca rluke@georgebrown.ca Lynda Atack latack@centennialcollege.ca latack@centennialcollege.ca