Usability Evaluation of a Tablet-Based Intervention to Prevent Intradialytic Hypotension in Dialysis Patients During In-Clinic Dialysis: Mixed Methods Study

Matthew Willis, Leah Brand Hein, Zhaoxian Hu, Rajiv Saran, Marissa Argentina, Jennifer Bragg-Gresham, Sarah L Krein, Brenda Gillespie, Kai Zheng, Tiffany C Veinot, Matthew Willis, Leah Brand Hein, Zhaoxian Hu, Rajiv Saran, Marissa Argentina, Jennifer Bragg-Gresham, Sarah L Krein, Brenda Gillespie, Kai Zheng, Tiffany C Veinot

Abstract

Background: Patients on hemodialysis receive dialysis thrice weekly for about 4 hours per session. Intradialytic hypotension (IDH)-low blood pressure during hemodialysis-is a serious but common complication of hemodialysis. Although patients on dialysis already participate in their care, activating patients toward IDH prevention may reduce their risk of IDH. Interactive, technology-based interventions hold promise as a platform for patient activation. However, little is known about the usability challenges that patients undergoing hemodialysis may face when using tablet-based informatics interventions, especially while dialyzing.

Objective: This study aims to test the usability of a patient-facing, tablet-based intervention that includes theory-informed educational modules and motivational interviewing-based mentoring from patient peers via videoconferencing.

Methods: We conducted a cross-sectional, mixed methods usability evaluation of the tablet-based intervention by using think-aloud methods, field notes, and structured observations. These qualitative data were evaluated by trained researchers using a structured data collection instrument to capture objective observational data. We calculated descriptive statistics for the quantitative data and conducted inductive content analysis using the qualitative data.

Results: Findings from 14 patients cluster around general constraints such as the use of one arm, dexterity issues, impaired vision, and lack of experience with touch screen devices. Our task-by-task usability results showed that specific sections with the greatest difficulty for users were logging into the intervention (difficulty score: 2.08), interacting with the quizzes (difficulty score: 1.92), goal setting (difficulty score: 2.28), and entering and exiting videoconference rooms (difficulty score: 2.07) that are used to engage with peers during motivational interviewing sessions.

Conclusions: In this paper, we present implications for designing informatics interventions for patients on dialysis and detail resulting changes to be implemented in the next version of this intervention. We frame these implications first through the context of the role the patients' physical body plays when interacting with the intervention and then through the digital considerations for software and interface interaction.

Keywords: dialysis; informatics intervention; usability; user interaction.

Conflict of interest statement

Conflicts of Interest: None declared.

©Matthew Willis, Leah Brand Hein, Zhaoxian Hu, Rajiv Saran, Marissa Argentina, Jennifer Bragg-Gresham, Sarah L Krein, Brenda Gillespie, Kai Zheng, Tiffany C Veinot. Originally published in JMIR Human Factors (https://humanfactors.jmir.org), 14.06.2021.

Figures

Figure 1
Figure 1
Screenshots from the tablet-based intervention: homepage showing the main to-do list (left panel), a typical educational model presenting content on intradialytic hypotension prevention with learning objectives (middle panel), and a quiz that is delivered after each session (right panel).
Figure 2
Figure 2
Screenshots from the tablet-based intervention showing a video library of hemodialysis patient stories (left), the quiz for module 1 (middle), and a question from the goal-setting module asking patients how often they will commit to adopting a certain behavior from the quiz.
Figure 3
Figure 3
Screenshots from the tablet-based intervention: supplemental materials related to each learning module that patients can email themselves to review outside of dialysis hours (left panel); goal-setting module wherein patients select values, traits, or characteristics most important to them (right panel).
Figure 4
Figure 4
Difficulty of use scores (scale of 1 to 3) for each intervention application feature. A score of 1 indicates the participant was able to accomplish the task on their own with little difficulty. A score of 2 indicates some difficulty and a score of 3 indicates considerable difficulty requiring assistance to complete the task. The y-axis represents the difficulty score, and the x-axis shows the task performed by the patients.

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