# A Systematic Review of the Usability of Telemedicine Interface Design for Older Adults
## 4 Discussion  
To facilitate the application of the results of this study in the development of telemedicine applications, we provide a design elements checklist in Table 2. These elements can be used to develop design guidelines and offer recommendations and identify factors that influence the interface usability across various levels of abstraction, covering the functional framework, interaction logic, visual design, and user experience in telemedicine. This makes them accessible for interface designers and developers. For each category, specific implementation and design elements relevant to telemedicine applications for the elderly were analyzed to facilitate the ease of use by designers and software developers. These design elements are applicable to various telemedicine applications aimed at older adults. This study indicates that the System Usability Scale (SUS) is the most commonly used evaluation method for telemedicine, although there remains a need to strengthen the experimental verification and evaluation. The research also revealed that only five studies were grounded in theory, including the User Center Design [73, 76, 88], Technology Acceptance Model (TAM) [19], Grounded Theory [86], and the Kano model [57]. However, existing studies primarily use theoretical models as design tools or analyze factors influencing acceptance, without closely integrating theoretical frameworks with interface design elements. Given that functionality, interactivity, esthetics, and user experience significantly impact the acceptance and usability of new technologies, this study aims to enhance the elderly acceptance of telemedicine. For the first time, it integrates key interface design elements with the TAM to develop a conceptual framework (Figure 2), guiding designers in creating effective telemedicine systems for older adults. Future studies should adopt theory-driven applied design to uncover the mechanisms behind design features relevant to aging theory. Current studies predominantly rely on interviews, focus groups, and questionnaires, with limited experimental evidence and a lack of comparison groups. Often, these studies evaluate entire applications rather than individual design elements, as noted by [PERSON] [42]. Given the diverse health and medical needs of older adults compared to younger individuals, it is essential to create an aging-friendly version of telemedicine interfaces. \begin{table}
\begin{tabular}{c c c} \hline \hline
**Evaluation Method** & **Evaluation Dimension and Rating Items (Define)** & **Reference** \\ \hline Questionnaire for User Interface Satisfaction (QUIS) & Readable design/typography, text writing style, layout, navigation, learn and use, memory load and mental effort, user guidance and error handling, cues, instructions and user control & [70] \\ \hline Nielsen’s usability model & Learnability, efficiency, memorability, error, and satisfaction & [13] \\ \hline Mobile App Rating Scale (MARS) & Application quality, engagement, functionality, esthetics, information, subjective quality & [58, 59] \\ \hline Suitability assessment of materials (SAM) & Content, literacy demand, graphics, layout and typography, learning stimulation and motivation, cultural appropriateness & [66] \\ \hline Health Information Technology Usability Evaluation Scale (H-ITUES) & Loyalty, interaction, usability feedback, and sentiment feedback & [71] \\ \hline A questionnaire survey & Challenges, readability, reliability, features feel difficult, intuitive rating design, easy to navigate, rating, used health & [69] \\ \hline No usability evaluation was conducted & [12, 18, 19, 52, 56, 57, 61, 63, 64, 65, 74, 80, 81, 82, 83, 84, 85, 88] \\ \hline \hline \end{tabular}
\end{table} 
Table 3: _Cont._While some scholars argue against developing separate versions [14], we advocate for a user-centered approach that tailors functions specifically for older users, thereby enhancing the design applicability to meet their needs.