JMIR Publications

ABSTRACT

Background:

Increasing demands on hospital care have accelerated the use of digital health technologies to improve efficiency and support patient-centered care. Bedside terminals have emerged as a promising solution for enhancing patient engagement and autonomy. However, their multifunctional design may create usability challenges, particularly for patients with lower digital health literacy, potentially contributing to inequitable access and use. User-centered usability evaluation is therefore essential to ensure adaptation to diverse patient populations. Despite this, evidence from comprehensive usability evaluations of bedside terminals remains limited.

Objective:

This study evaluated the usability of a bedside terminal among hospitalized patients with varying levels of digital health literacy and identified usability problems to derive interface redesign recommendations.

Methods:

The usability evaluation was conducted among 16 hospitalized medical and surgical patients recruited at a Danish regional hospital and stratified according to digital health literacy levels. Participants completed 6 predefined tasks using a retrospective think-aloud protocol, followed by the System Usability Scale questionnaire. Usability measures were assessed by task completion rate, time ratio for successfully completed tasks, and perceived satisfaction. Associations between digital health literacy and usability outcomes were examined using linear regression analyses. Qualitative think-aloud transcripts and observational data were analyzed using deductive thematic analysis guided by Nielsen’s 10 heuristics to identify and prioritize usability problems and derive interface redesign recommendations.

Results:

Participants completed 62.5% of tasks without assistance, indicating low effectiveness. The mean time ratio was 2.6, corresponding to moderate efficiency, and the mean System Usability Scale score was 58.3, indicating low perceived satisfaction. Digital health literacy was significantly associated with task completion rate (P<.001) and satisfaction (P=.02), whereas no significant association was observed with time ratio (P=.10). The think-aloud analysis identified 19 usability problems, primarily related to unclear function names and icons, inconsistent design elements, and insufficient system feedback. These findings informed 4 interface redesign recommendations targeting the most critical usability problems.

Conclusions:

The bedside terminal demonstrated low overall usability, and the association between digital health literacy and usability highlights the need for more inclusive, user-centered design to support equitable use of bedside terminals across hospitalized patient populations.