Usability Engineering for Medical Apps using the Example of an App for Epilepsy Self-Management with a Neurosensing System
Authors: Effert Jana-Sophie , Esser Birgitta , Buschermoehle Michael , Henze Jasmin , Warnecke Maren , Surges Rainer , Houta Salima 
Published: July 2022

Background: Recognizing and documenting epileptic seizures in everyday life is fundamentally important for the precise therapy of those affected. However, studies on seizure diaries have shown that up to 45% of seizures that can be recorded via EEG are not documented by the diarists (Hoppe et al., 2007). To address this gap, the MOND project (Mobile Smart Neurosensing System for the Detection and Documentation of Epileptic Seizures in Daily Life) is working on a wearable neurosensor system. As part of this project, an app that is connected to the sensor is being developed to assist users with epilepsy management. Objective: This research aims at developing and evaluating a digital epilepsy diary that simultaneously shows the data collected via the sensor system and can be used as a tool simplifying the physician-patient-communication. The main objective pursued in this paper is to describe the user centered design process with focus on long-term usage support. Therefore, we address the following questions: How can seizure documentation be supported by the app design? Do an avatar concept and dialogue-based interaction promote long-term usage? Methods: We follow a user-centered design approach. The work is based on an app developed in the previous EPItect project (Houta et al., 2020), which was already evaluated in its basic functions but not so much regarding usability issues. User perspectives were included iteratively throughout the whole process: At the beginning, a heuristic evaluation was carried out to identify which features need to be revised. For considering the integration of the app into everyday life of patients, storytelling was used to describe the care process. Added to the requirements already known from the Epitect project, these findings culminate in a developed design for the MOND-App including an avatar-based prototype. User feedback was conducted before, during and after the design process through user workshops and semistructured interviews with a small sample (four patients). Results: The results of the evaluation phase show acceptance of the avatar concept, in particular with dialogue-like interaction being seen as superior to long texts. At the same time, there was skepticism about whether an avatar can really lead to increased motivation in the long term. The collected user feedback also shows which concerns arise regarding data protection and could thus prevent use, the areas in which certain input methods (such as lists) are particularly desirable, and the areas of the app that require increased customizability. These latter areas primarily concern the nomenclature of symptoms and seizure types, which is often created independently by patients. Conclusions: The results of the interviews show a high willingness to use the app, as important functionalities supplemented by suitable input formats and dialogue-like interaction were positively evaluated. At the same time, customizability – mainly in the naming and description of symptoms and seizure types outside clinical classifications – is an important aspect in the development of an app for epilepsy management. The long-term impact and use of such an app need to be assessed in follow-up studies after full development. Hoppe, C., Poepel, A., & Elger, C. E. (2007). Epilepsy: accuracy of patient seizure counts. Archives of neurology, 64(11), 1595-1599. Houta, S., Meschede, C., Beeres, K., Surges, R., & Klötgen, M. (2020). USER-CENTERED DESIGN AND EVALUATION OF STANDARD-BASED HEALTH TECHNOLOGIES FOR EPILEPSY CARE.