Background/Purpose: Patient passports have been used in chronic diseases to promote the active involvement of patients in their care, and have led to better treatment and health outcomes. In rheumatoid arthritis (RA), the ‘Treat to Target’ approach emphasizes the importance of regular assessment and modifying therapy until the target (remission or low disease activity) is reached. Active involvement of RA patients in monitoring their own disease activity could facilitate this approach by providing early warning when targets are not being met. The Arthritis Health Journal (AHJ) is a patient-centered online tool that helps patients track symptoms, monitor disease activity and develop action plans. This study aims to evaluate user satisfaction with the AHJ and to identify usability issues that will help refine the tool.

Methods: Development of the AHJ was guided by a series of semi-structured interviews with patients and rheumatologists. The tool consists of six sections: 1) symptom and exercise log; 2) disease activity assessment; 3) mood assessment; 4) medical information; 5) goals and action plans; 6) health reports.

Two iterative cycles of usability testing were conducted with people with RA using the concurrent think-aloud protocol, in which participants are asked to verbalize their thoughts while performing a set of tasks. Sessions were audio-recorded and field notes were taken. The System Usability Scale (SUS) was used to evaluate the usability of the tool (min-max=0-100; higher=more user friendly) and simple content analysis was performed to identify issues and refine the tool.

Results: Usability testing was conducted with nine participants with RA – five in the first iteration and four in the second iteration. Mean (SD) RA duration was 11y (12.6); mean (SD) age was 51.6y (10.2). All participants were female and most (89%) were college or university educated. Mean (SD) daily internet use was 4h (2.2). The tool’s overall usability was good, with a mean (SD) SUS score of 84.7 (7.7).

Participants responded positively to the content and design of the AHJ, reporting particular satisfaction with the ability to view patterns over time and relationships between symptoms and other aspects of their disease or management. Graphical representation of results was viewed as an effective method of displaying these patterns.

Aspects of the interface that were modified after the first iteration led to improved satisfaction in the second iteration. Ensuring font types, sizes and colours were easy to read was essential to user satisfaction. Participants rarely read text or instructions, so long blocks of text were replaced with simple and succinct instructions, and key points were emphasized to ensure important details were understood. Particularly, instructions regarding time frame in analog scale questions (e.g. in the past week) tended to be ignored or go unnoticed, until questions were reformatted in the second iteration to more clearly emphasize the time frame.

Conclusion: Direct observation methods provided valuable insight into the use of online tools to promote active involvement of patients in their care. While general satisfaction was high, usability testing revealed important issues that warranted improvement to refine the prototype.

---

« Back to 2013 ACR/ARHP Annual Meeting

ACR Meeting Abstracts - https://acrabstracts.org/abstract/development-and-usability-testing-of-the-arthritis-health-journal-an-online-tool-to-promote-self-monitoring-in-people-with-rheumatoid-arthritis/