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

Bogza, Laura-Mihaela; Patry-Lebeau, Cassandra; Farmanova, Elina; Witteman, Holly O; Elliott, Jacobi; Stolee, Paul; Hudon, Carol; Giguere, Anik M C

doi:10.2196/17406

Cited by 53Patient-Provider Communication in HealthcareDementia and Cognitive Impairment ResearchElectronic Health Records Systems

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

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Bogza, Laura-Mihaela, Patry-Lebeau, Cassandra, Farmanova, Elina, Witteman, Holly O, Elliott, Jacobi, Stolee, Paul, Hudon, Carol, Giguere, Anik M C·2020·Journal of Medical Internet Research

DOI 10.2196/17406PMC PMC7468645

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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.

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Multiple authors in the included studies stated that ideally, multiple methods should be combined to paint a full picture of a prototype's usability.
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Authors: Bogza, L.-M., Patry-Lebeau, C., Farmanova, E., Witteman, H. O., Elliott, J., Stolee, P., Hudon, C., & Giguere, A. M. C.
Affiliations: Université Laval (CA)
University of Toronto (CA)
University of Waterloo (CA)
Corresponding author: Giguere, Anik M C
ORCID: Bogza, Laura-Mihaela
Patry-Lebeau, Cassandra
Farmanova, Elina
Witteman, Holly O
Elliott, Jacobi
Stolee, Paul
Hudon, Carol
Giguere, Anik M C
Venue: Journal of Medical Internet Research
Publisher: JMIR Publications Inc.
Published: 2020-08-19
Volume: 22
Issue: 8
Pages: e17406
ISSN: 1438-8871 (ISSN-L)
DOI: 10.2196/17406
PMC: PMC7468645
OpenAlex: W3017295914
Cited by: 52
References: 65
Citations by year: 2026: 9 · 2025: 7 · 2024: 12 · 2023: 7 · 2022: 8 · 2021: 8 · 2020: 1
FWCI: 6.26
Type: journal article
Language: en
Open access: gold
doi.org
Licence: cc-by
Locations: Journal of Medical Internet Research (publishedVersion, cc-by)
PubMed Central (publishedVersion, cc-by)
PubMed (publishedVersion)
DOAJ (DOAJ: Directory of Open Access Journals) (submittedVersion, cc-by-sa)
Funders: Université Laval
Government of Canada
Canadian Frailty Network
Canadian Institutes of Health Research
Topics: Health Sciences › Health Professions › General Health Professions › Patient-Provider Communication in Healthcare
Health Sciences › Medicine › Psychiatry and Mental health › Dementia and Cognitive Impairment Research
Health Sciences › Health Professions › Health Information Management › Electronic Health Records Systems
Keywords: mild cognitive impairment, web-based decision aid, user-centered design, values clarification, informed decision-making, older adults, healthcare workers, usability, decisional conflict, cognitive function maintenance, clinical decision support, user testing, teach-back, plain language, interface design, caregivers, dementia risk, informed consent, informed refusal
MeSH terms: User-Centered Design, Aged, Aged, 80 and over, Decision Support Techniques, Female, Health Personnel, Humans, Male, Middle Aged, Internet, Cognitive Dysfunction

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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

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