JMIR Publications

ABSTRACT

Background:

Quality of life (QoL) assessments, or patient-reported outcome measures (PROMs), are becoming increasingly important and can improve decision making, satisfaction, and outcomes of care. Some physicians and patients find questionnaires too burdensome, which could be reduced by using computerized adaptive testing. Furthermore, questionnaire user experience might increase by making a questionnaire more interesting, for example by providing graphical and contextualized feedback. However, little is known about how shorter assessments and feedback impact user experience.

Objective:

We conducted a controlled experiment to assess the impact of tailored multimodal feedback and computerized adaptive testing on user experience in QoL assessment using validated PROMs.

Methods:

We recruited a representative sample from the general population in the United Kingdom using the Oxford Prolific academic web panel. Participants completed either a computer adaptive testing version of the World Health Organization Quality of Life assessment (WHOQOL-CAT) or the fixed-length WHOQOL-BREF. We randomly assigned participants to conditions in which they would receive either no feedback, graphical feedback only, or graphical and adaptive text feedback. Participants rated the assessment in terms of perceived acceptability, engagement, clarity, and accuracy.

Results:

We included 1386 participants in our analysis. Assessment experience was improved when graphical and tailored text feedback was provided together alongside PROMs (p<0.001, Δ=0.22). Providing graphical feedback alone was not associated with improvement in overall experience (p=0.006, Δ=0.10). Graphical and text feedback made the questionnaire more interesting and users were more likely to share the results with a physician or family member (p<0.001, Δ=0.17, and p<0.001, Δ=0.17, respectively). No difference was found in perceived accuracy of the graphical feedback scores of the WHOQOL-CAT and WHOQOL-BREF (p=0.05, Δ = 0.06). Computerized adaptive testing resulted in a 25% item reduction (SE<0.45) compared to the fixed-length assessment but did not result in an increased user experience (p=0.21).

Conclusions:

Using tailored text feedback to contextualize numeric scores maximized the acceptability of electronic QoL assessment. Improving user experience may increase response rates and reduce attrition in research and clinical use of PROMs. In this study, CAT administration was associated with a modest decrease in assessment length but did not improve user experience. Patient perceived accuracy of feedback was equivalent when comparing CAT with fixed-length assessment. Further research is warranted to explore the relationship between assessment length, feedback, and response burden in diverse populations.