Usability Testing of a Progressive Web App for Women with Cardiac Pain (Preprint)
Authors: Parry Monica , Huang Tony , Clarke Hance , Bjørnnes Ann Kristin , Harvey Paula , Norris Colleen , Parente Laura , Pilote Louise , Price Jennifer , Stinson Jennifer N , O’Hara Arland , Fernando Madusha , Watt-Watson Judy , Nickerson Nicole , Spiteri DeBonis Vincenza , Hart Donna , Faubert Christine 
Published: February 2024

BACKGROUND

Cardiac pain has been widely considered to be the primary indicator of coronary artery disease. The presentation of cardiac pain and associated symptoms vary in women, making it challenging to interpret as cardiac, possibly cardiac, or non-cardiac. Women prefer to consult with family and friends instead of seeking immediate medical care.

OBJECTIVE

To assess user performance (i.e., ease of use, efficiency, and errors) and user satisfaction (SUS) with the content and functionality of a progressive Web App for women with cardiac pain.

METHODS

Following ethics approval, a purposive sample of women over 18 years with cardiac pain or associated symptoms lasting greater than 3 months, and able to speak and read English were recruited to participate in two iterative usability testing cycles. The first cycle assessed the performance and satisfaction of at heart using a web-based computer interface and the second cycle assessed the performance and satisfaction of at heart across various Android and Apple iOS devices. Two investigators recorded user comments and documented problems. Three error types were captured: 1) navigation errors, 2) presentation errors, and 3) control usage errors. At the end of the testing session, the participants completed the System Usability Scale (SUS) and four semi-structured interview questions.

RESULTS

Ten eligible women participated in usability testing from March 31st to April 17th, 2020 (Cycle 1) and November 17th to November 30th, 2020 (Cycle 2). Women across usability cycles had a mean age of 55.6 years (SD 7.3) and most were well educated (n=9, 90%). Fifty percent of women were employed full or part time and earned greater than $70,000 Canadian dollars annually (n=6, 60%). Participants across two cycles of testing reported the overall usability of the at heart web-based application as highly acceptable (SUS mean 81.75, standard deviation [SD] 10.41). Nine (90%) participants rated the user-friendliness of at heart as good or excellent. All participants (n=10, 100%) thought at heart was easy to use and efficient. Only two testing errors were noted as high priority, these were low contrast/small font and clarification that the Chatbot was not a real person. User satisfaction was assessed using themes that emerged from the debrief and four semi-structured interview questions; at heart was engaging, comprehensive, understandable, credible, relevant, affirming, personalized, and innovative.

CONCLUSIONS

at heart is the first of its kind; no smartphone or web-based self-management program has been co-designed and systematically developed with women who have lived experience, and then tested with women who have cardiac pain. This study provides strong initial support for the at heart web-based application for women living with cardiac pain and cardiac symptoms. Findings from the second usability testing cycle will be used to refine the prototype prior to the pilot randomized controlled trial.

INTERNATIONAL REGISTERED REPORT

RR2-10.1136/bmjopen-2019-033092