Remote Cognitive Screening in Primary Care via an mHealth App: A Formative Usability Evaluation of MyCog Mobile (Preprint)
Authors: Young Stephanie Ruth , Lattie Emily Gardiner , Berry Andrew BL , Bui Lynn , Byrne Greg Joseph , Yoshino Benavente Julia Noelani , Bass Michael , Gershon Richard C , Wolf Michael S , Nowinski Cindy J 
Published: September 2022

BACKGROUND

Annual cognitive screening in adults over age 65 can improve early detection of cognitive impairment, yet less than half of all cases are identified in primary care. Time constraints in primary care settings present a major barrier to routine screening. A remote cognitive screener completed on a patient’s own smartphone prior to a visit has the potential to save primary care clinics time, encourage broader screening practices, and increase early detection of cognitive decline.

OBJECTIVE

We describe the design and proposed implementation of a remote cognitive screening app, MyCog Mobile, to be completed on a patient’s smartphone prior to an annual wellness visit. Research questions included: 1) What would motivate primary care clinicians and clinic administrators to implement a remote cognitive screening process?; 2) How might we design a remote cognitive screener to fit well with existing primary care workflows?; 3) What would motivate an older adult patient to complete a cognitive screener on a smartphone prior to a primary care visit?; and 4) How might we optimize the user experience of completing a remote cognitive screener on a smartphone for older adults?.

METHODS

To address research questions 1 and 2, we conducted foundational interviews with clinicians (N=5) and clinic administrators (N=3). We also collaborated with clinic administrators to create user journey maps of their existing and proposed MyCog Mobile workflows. To address research questions 3 and 4, we conducted individual semi-structured interviews with older adults (N=5) and solicited feedback from a community stakeholder panel (N=11). We also tested and refined high-fidelity prototypes of the MyCog Mobile app with the older adult interview participants, who rated the usability on the Simplified System Usability Scale (S-SUS) and After Scenario Questionnaire (ASQ).

RESULTS

Clinicians and clinic administrators were motivated to switch to a remote cognitive screening process if it saved time in their workflows. Findings from interviews and user journey mapping informed the proposed implementation and core functionality of MyCog Mobile. Older adult participants were motivated to complete cognitive screeners to ensure they were cognitively healthy and saw additional benefits to remote screening such as saving time during their visit and privacy. Older adults also identified challenges to remote smartphone screening, which informed the user experience design of the MyCog Mobile app. The average rating across prototype versions was 91 (SD 5.18) on the S-SUS and 6.13 (SD 8.40) on the ASQ, indicating above average usability.

CONCLUSIONS

Through an iterative, human-centered design process, we were able to develop a viable remote cognitive screening app and proposed implementation strategy for primary care settings that was optimized for multiple stakeholders. Next steps include validating the cognitive screener in clinical and healthy populations and piloting the finalized app in a community primary care clinic.