Armando James Rotondi*, University of Pittsburgh, VA VISN4 Mental Illness Research, Education and Clinical Center (MIRECC), Pittsburgh, United States Track: Research Presentation Topic: Usability and human factors on the web Presentation Type: Oral presentation Submission Type: Single Presentation Building: Joseph B. Martin Conference Center at Harvard Medical School Room: B-Bray Room Date: 2012-09-15 02:45 PM – 03:30 PM Last modified: 2012-09-12

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Background: There has been little work to design e-health applications for those with severe mental illness (SMI), who often have significant cognitive impairments. We developed an empirically-supported design model termed the Flat Explicit Design Model (FEDM). Using this model we created a web-based intervention termed Schizophrenia On-line Access to Resources (SOAR) to provide in-home multi-family psychoeducational treatment to persons with schizophrenia, and their family members. The intervention had significant effects on important outcomes (e.g., patient positive symptoms and knowledge of schizophrenia).
Objective: To further evaluate this model and gain additional insights into the design needs of persons with SMI we conducted two studies. The first compared the design and usability of SOAR to four public websites with information on schizophrenia. In the second study we developed and tested the design concept of screen complexity as potentially important to the cognitive effort required to comprehend and effectively navigate a screen or e-health application, and; thus, to usability for persons with SMI. Our model of screen complexity includes the constructs of distinct topic and navigation areas of a screen, the number of columns used to organize a page’s contents, number of words and hyper links on a page, and the text’s readability. We hypothesized that these variables would effect the ability of persons with SMI to navigate e-health applications.
Methods: Thirty eight persons with schizophrenia performed tasks to evaluate the 5 websites. Linear mixed-effects regression models were used to examine usability of the websites. Omnibus tests of between-site differences were conducted, followed by post-hoc pairwise comparisons of means to examine specific website differences when omnibus tests reached statistical significance.
Results: SOAR required less time to find information, had a higher success rate, and was rated easier to use and less frustrating than the others. The homepage design of one of the other websites provided the best content disclosure, i.e., revealed the site’s contents. Our model of page complexity, and its subcomponents, were significantly related to a users’ performance on the five websites. These studies’ results were used to expand the FEDM (Table 1), which is designed to reduce the cognitive effort required to effectively use an e-health application via limiting users’ need to: 1) think abstractly( #14, #15, #16, #17,#18); 2) rely on working memory ( #3, #7, #8, #11, #12); 3) utilize executive functions, (#2, #6, #8, #9); 4) focus ( #2) , and; 5) scan and search for information (Table 1, #1, #3, #11, #4, #10, #5, #13).
Conclusions: The FEDM provides evidence based guidelines to design e-health applications for person with SMI, and others with cognitive impairments.
Table 1. Elements of the FEDM
Page Complexity
1. Minimal Introduction
2. Plain Pages
3. Minimal Navigation Areas
4. Minimal Topic Areas
5. Minimal Themes
Navigation Simplicity
6. Shallow Hierarchy
7. Use of Memory Aids
8. Scrolling vs. Paging
9. Use of Toolbar
10. Information Arrangement
11. # Links
12. Content Organization
13. Link Location
Meaning Comprehension
14. Content Inference
15. Explicit Labels
16. Reading Level
17. User Dialect
18. Text Quantity