Usability evaluation with mental health professionals and young people to develop an Internet-based cognitive-behaviour therapy program for adolescents with anxiety disorders
Open accessAbstract
BACKGROUND: Use of the Internet to deliver cognitive behavioural therapy, a frontline treatment for anxiety disorders, is emerging as an option to increase access to treatment among adolescents with anxiety disorders. This study examined the usability of the Internet-based component of Breathe, a CBT program designed for adolescents with mild to moderate anxiety and impairments. METHODS: A mixed-method usability testing design with semi-structured interviews, task completion, and survey by trained usability moderators was undertaken with two interactive cycles to determine the usability (ease of use, efficiency, errors, and user satisfaction) of the user interface and content areas of the program. Purposeful sampling was used to recruit mental health clinicians with expertise in treating adolescent anxiety disorders and young people aged 15 to 24 years involved. Testing involved using Web-conferencing software that allowed remote participation through personal computers. Two testing cycles involved participants completing structured 'think aloud' and 'cognitive walkthrough' tasks within the program. At the end of each cycle participants completed a 15-item global usability evaluation survey and were asked a series of open-ended questions. Descriptive and simple content analyses were used to identify and score usability issues for frequency and severity. RESULTS: Five clinicians and four young people (all < 20 years of age) participated. Most participants described their computer skills as 'good' (60% clinicians, 50% young people), and attitudes toward Internet-based health care ranged from negative (75% young people) to positive (60% clinicians, 25% young people). Scores from the global usability evaluation after both testing cycles ranged from 3.5 to 5 out of 5 in strong agreement/support of the program in terms of user performance indicators (i.e., learnability, efficiency and number of errors) and user satisfaction. Participants were able to complete all critical tasks with minimal errors. Errors and issues identified during testing were predominantly around enhancements to the visual design and navigational support. Opinions across usability elements did not differ between young people and clinician participants. CONCLUSIONS: A multi-method remote usability approach provided the opportunity to improve the technical interface, therapeutic messaging and user experience of an Internet-based treatment program for adolescent anxiety disorders.
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Considering UX can help create a positive experience toward using the platform, increasing the probability of meeting the objectives and decreasing the probability of developing Complicated Grief Disorder.
“Also, along with the study of Wozney et al. (2015), considering the UX can help to create a positive experience toward using the platform, therefore increasing the probability of meeting the objectives in our study, and decreasing the probability of developing Complicated Grief Disorder.”
From A Self-Applied Multi-Component Psychological Online Intervention Based on UX, for the Prevention of Complicated Grief Disorder in the Mexican Population During the COVID-19 Outbreak: Protocol of a Randomized Clinical Trial (2021) · cites this paper as Wozney et al. (2015)
The Background (page unavailable) says that user-experience design should fit users’ needs and that a poorly matched interface can reduce satisfaction and effectiveness. The Results’ Site aesthetics section (page unavailable) also links design to usability and satisfaction. The paper evaluates an anxiety program for adolescents; it does not establish that UX improvements increase the citing study’s chance of meeting its objectives or reduce the risk of Complicated Grief Disorder. (LLM, conf=0.88)
Experimental — accuracy not yet measuredThe System Usability Scale (SUS) has increasingly been applied to measure usability of internet-based cognitive behavioural therapy (iCBT) in feasibility and evaluation studies in mental healthcare.
“In feasibility and evaluation studies on iCBT in mental healthcare, the System Usability Scale (SUS) has increasingly been applied to measure usability [7–9]”
From Dimensionality of the system usability scale among professionals using internet-based interventions for depression: a confirmatory factor analysis (2020) · cites this paper as [8]
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Self-citationOnline Support and Intervention for Child Anxiety (OSI): Development and Usability Testing
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“To the best our knowledge, only a few studies describe the inclusion of end users in the design of ICBT interventions for children and adolescents with anxiety [16,19,20].”
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“Remote, synchronous usability testing has previously been shown to be as effective as in-person usability testing for eHealth interventions among both adults and youth [11].”
Self-citationMeet my HUBBI : he's an expert on eHealth usability
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Torres-Silva, E. A., Gaviria, J., Pereira-Montiel, E., Arenas, D. A. M., & Florez-Arango, J. F. (2025) · JMIR Formative Research · doi:10.2196/58909
“This is consistent with findings from previous studies showing that iterative and participatory usability evaluations with both clinicians and end users can significantly improve system navigation, content structure, and user satisfaction prior to system deployment [22].”
Mol, M., van Schaik, A., Dozeman, E., Ruwaard, J., Vis, C., Ebert, D. D., Etzelmueller, A., Mathiasen, K., Moles, B., Mora, T., et al. (2020) · Figshare · doi:10.6084/m9.figshare.12291794
Liu, Y., Yang, Y., & Xu, Q. (2026) · BMC Psychology · doi:10.1186/s40359-026-04285-z
“The interventions can include cognitive-behavioral therapy and acceptance and commitment therapy and mindfulness-based approaches and psychoeducation and structured self-management programs which can be delivered through self-guidance or therapy assistance [18–20].”
Ilie, A., Keys, E., Pencer, A. H., Weiss, S. K., & Corkum, P. V. (2026) · JMIR Formative Research · doi:10.2196/91150
“…suggested adding additional resources for parents and HCPs, removing some program content, and increasing program interactivity, which aligns with other research where HCPs have found programs more effective when given applicable information that they can apply directly in practice [38,39].”
- Authors
- Wozney, L., Baxter, P., & Newton, A. S.
- Affiliations
- Izaak Walton Killam Health Centre (CA)
- McMaster University (CA)
- University of Alberta (CA)
- Corresponding author
- Wozney, Lori
- Venue
- BMC Pediatrics
- Published
- 2015-12
- Volume
- 15
- Issue
- 1
- Pages
- 213-213
- ISSN
- 1471-2431 (ISSN-L)
- PMC
- PMC4682240
- OpenAlex
- W2197874918
- Cited by
- 38
- References
- 56
- Citations by year
- 2026: 3 · 2025: 7 · 2024: 3 · 2022: 6 · 2021: 3 · 2020: 6 · 2019: 5 · 2018: 3 · 2017: 1 · 2016: 1
- FWCI
- 2.70
- Type
- journal article
- Language
- en
- Open access
- gold
- doi.org
- Licence
- Locations
- BMC Pediatrics (publishedVersion, cc-by)
- Europe PMC (PubMed Central) (publishedVersion, cc-by)
- PubMed Central (publishedVersion, cc-by)
- PubMed (publishedVersion)
- Funders
- Canadian Institutes of Health Research (FRN119531)
- Topics
- Social Sciences › Psychology › Applied Psychology › Digital Mental Health Interventions
- Physical Sciences › Computer Science › Human-Computer Interaction › Usability and User Interface Design
- Social Sciences › Psychology › Experimental and Cognitive Psychology › Anxiety, Depression, Psychometrics, Treatment, Cognitive Processes
- Keywords
- usability evaluation, internet-based cognitive behavioral therapy, adolescent anxiety disorders, user interface design, remote usability testing, think-aloud, cognitive walkthrough, clinician perspectives
- MeSH terms
- Adolescent, Adult, Anxiety Disorders, Cognition, Female, Health Personnel, Humans, Male, Mental Health, Software, User-Computer Interface, Cognitive Behavioral Therapy, Patient Satisfaction, Internet, Young Adult
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