User-centered Design of a PHR: Traditional Web Forms vs. Wizard Forms [5 Cr2 1100 Purin]

Purin, B. et al.:User-centered Design of a PHR: Traditional Web Forms vs. Wizard Forms

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User-centered Design of a PHR:

Traditional Web Forms vs. Wizard Forms

Barbara Purin and Emiliano Ricci

FBK, Fondazione Bruno Kessler, Trento, Italy

e-HealthApplied Research Unit

Friday, September 5, 2008


The Department of Health

and the Department of Research and Innovation

of the Autonomous Province of Trento (NE Italy)

have funded a feasibility study of a

Personal Health Information Management (PHIM) System

for the citizens living in the Province.

PHIM refers to activities that support

consumers’ access, integration, organization,

and use of their personal health information.

PHIM activities rely on the collection and management

of one’s own personal health information collected

from each health care provider

plus any health information you want to add.

The Autonomous Province of Trento

The Department of Health

Andrea Civan, Meredith M.

Skeels, Anna Stolyar and Wanda

Pratt, Personal Health

Information Management: Consumers’

Perspectives. AMIA Annu Symp

Proc. 2006; 2006: 156-160

Considerable effort was dedicated to guide and support the management of

health information in the System design phase.



- Exploring the effectiveness of the traditional web

forms vs. wizard step-by-step structure;

- gathering information about problems that users may

encounter when interacting with such interfaces;

- understanding which system, if any, improve more the

data entry process and attracts more users.

We focused on testing usability and

user experience of two user interfaces

designed and developed to support

citizens to maintain drugs’

information themselves.

Input data forms and navigation

are crucial elements;

they would be used consistently

in order not to compromise the use of the

System.

REMARKS:

Widespread and extensive use of traditional and

wizard form layouts for data

input and configuration in

Web applications.



PHASE 1: Informal early evaluation of each user interface

- think-aloud technique: observing users while surfing the prototypes and filling the data input forms;

- post-task questionnaire based on a Likert-type scale for assessing user satisfaction;

- debriefing semi-structure interview for exploring subjective user experience behind what was previously observed.

PHASE 2: Formal evaluation based on the comparison of the two user interfaces


- Interactive, software-based prototypes;

- scenario prototypes.


Scenario prototypes are task oriented;

we decided to fully implemented two important tasks

that cut through the functionalities of the prototypes.

No differences between the prototypes

as regards the content.



Stories of common real life drug prescription:

- recording a new therapy and specify drug dosage;

- recording a therapy evaluation.

Task #1, Recording a new therapy

Goals: entering new therapy data (drug name, confection, reason for consumption, therapy start date); the task is complete when the form is filled and saved (data are displayed in a not-editable format ).Inputs: --- Assumptions: ---Steps: the user has to (…)



- overview of all requested information;

- data fields can be filled at any order;

- need of vertical scrollbar;

- check values before saving data.

THE TRADITIONAL WEB FORM BASED USER INTERFACE (briefly ‘TRADITIONAL UI’)

ALL DATA IN A SINGLE PAGE

A screenshot of the prototype.



DATA PRESENTED IN A STEP-BY-STEP

STRUCTURE

- list of data entered previously by the user on the top of the page;

- ordered sequence of small input data forms;

- NO need of vertical scrollbar;

- check values inserted in the form before moving from one step to the next one. A screenshot of the prototype.


THE WIZARD WEB FORM BASED USER INTERFACE (briefly ‘WIZARD UI’)


e-Health researchers and software engineers (8 people) working in the Bruno Kessler Foundation (FBK) and not involved in this work,

were asked to find the usability problems with the interfaces

without specifying any set of general principles to follow.

- they were asked to review the system interfaces and to perform the tasks by working separately and without assistance;

- a brainstorming was then performed to point out problems and

suggestions.

THE EVALUATION PROCESS:

We were

interested in

the point of

view of skilled

users with no

training or

experience in

usability

engineering.



CONTENT: some specific, local problems as regards labels, combo boxes’ values, and radio buttons;

NAVIGATION: navigation problems from screen to screen; drug information needed to being organized in Main data, Dosage, and Therapy evaluation web tabs;

reminder functionalities about end therapy and drug assumption were added to the prototypes.

At the end of

this evaluation,

the two

prototypes

were refined

according to

the comments

and

suggestions.



8 participants [1] (women) recruited among the administrative personnel of the Bruno Kessler Foundation (FBK).

INCLUSION CRITERION: skill in using the web (use of Internet from more than 1 yearand for at least 1 hour per week)

[1] Nielsen, J. “Why You Only Need to Test with 5 Users”, http://www.useit.com

Age range (years)19-2930-3940-49

More than 50

3140

Educational qualificationHigh school

Univesity53

Internet experienceLess than one year

More than one year08

Time spent using the internetLess then 3 hours per week

3-6 hours per weekMore than 6 hours per week

242

Reason for using the InternetOnly at homeOnly at work

Both

044

Usability test participants’ characteristics

COMPARISON TEST: - 4 of them used first the traditional UI and then the wizard UI; - the others used first the wizard UI and then the traditional UI.



DATA GATHERING: reports were transcribed in a world processing file;

a content analysis was performed.

Users were encouraged to “think aloud” commenting on any difficultiesthey encountered while performing the tasks.

(Kushniruk, A.W., & Patel, V.L. (2004). Cognitive and usability engineering methods for the evaluation of clinical information systems. Journal of Buomedical Informatics, 37, 56-76)

CODING CATEGORIES:

navigation, graphics, layout/screen organization, color,

resolution, meaning of labels,

understanding of system instruction/error messages,

consistency of operations, overall ease of use,

response time, visibility of system status,

data not displayed, data entry




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Category of usability problems

Fre

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Traditional UI Wizard UI

Total usability problems

by category



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Category of usability problems

Fre

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Traditional UI Wizard UI

- Chart 1 -

Usability problems funded by the subgroup of participants that used first the traditional UI and then the wizard UI.

- Chart 2 -

Usability problems funded by the subgroup of participants that used first the wizard UI and then the traditional UI.

0

2

4

6

8

10

12

Category of usability problemsF

req

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Wizard UI Traditional UI


At the end of the tasks, users were asked to fill a questionnaire for assessing user satisfaction.

USER & SYSTEM INTERFACE

QUESTION

User A User B User C User D User E User F User G User Hp = traditional web formw = wizard web form

p w w p p w w p p w w p p w w p

MEAN p MEAN w

easy to understand -1 -1 -3 0 1 2 1 2 0 1 1 2 2 2 -2 -1 0,625 0,125

easy to use 1 1 3 2 -1 2 -1 -2 1 1 2 2 3 2 2 2 1 1,5

intuitive 0 0 2 1 0 2 0 1 2 2 -1 2 2 2 -2 -2 0,75 0,625

interesting 2 2 2 2 0 2 2 -2 1 2 0 0 2 2 2 2 0,875 1,75

clear -1 -1 2 2 1 2 -1 1 2 1 1 1 2 2 2 1 1,125 1

comfortable -1 -1 2 2 1 2 0 0 1 2 0 0 3 2 1 0 0,75 1

engaging 3 3 2 2 0 2 1 -2 2 2 0 0 2 1 0 0 0,875 1,375

satysfying -1 -1 2 2 2 2 -1 2 0 2 0 0 2 1 1 0 0,875 0,75

I like 1 1 3 2 2 2 1 -2 2 -2 0 2 3 1 0 0 1,25 0,75

pleasant -2 -1 3 3 2 2 2 -1 2 2 1 1 2 2 2 2 1,125 1,625

MEAN (range [-3,3]) 0,1 0,2 1,8 1,8 0,8 2 0,4 -0,3 1,3 1,3 0,4 1 2,3 1,7 0,6 0,4 0,925 1,05

COLLECTED DATA: questions were based on the seven-point Linkert semantic scale; each response was converted to a numerical value in the range [-3,3].

FINDINGS: the user satisfaction is basically positive (1);no statistical differences between the two interfaces (2).



User’s opinions about the preferred interface were gathered during the debriefing phase of the tests.

FINDIGS:


WEB FORM LAYOUT # PREFERENCES REASON

TRADITIONAL WEB FORM

3 more comfortable; (plenty of) data in a single page (“in a wizard form I don’t know which information will be required in the following step”); data are aggregated;

WIZARD WEB FORM 4 “it is easier to use”; data are entered step-by-step; it calls your attention on the data you are entering; “I see both data entered previously and information required by the form to be filled”

1 user was not able to state the preferred interface because in her opinion the two interfaces were similar.


No one user interface seems to prevail against the other.

The most frequent usability issues encountered by the users were related to clearly-defined content and navigation problems.


The incidental preference coming from the debriefing interview was founded on subjective impressions.


Repeated cycles of design-testing-measure-redesign allow pointing out wrong design assumption about a system

that could cause usability problems later.


Comparison tests (different prototypes matched against each other)avoid to commit too early to one design that could reveal its faults only later.

The two prototypes are going to be refined according to the founded usability issues;

then a usability test with participants (both women and men) less skilled in using the web will be performed.

It could be interesting to evaluate the two interfaces after people have used one of them for a period of time.

http://www.fbk.eu

http://ehealth.fbk.eu


Thank youfor your attention


Health & Medicine

User-centered Design of a PHR: Traditional Web Forms vs. Wizard Forms [5 Cr2 1100 Purin]