JMIR Publications

ABSTRACT

Background:

Internet-based cognitive behavior therapy (ICBT) can be effective in mental and somatic health care. Research on the feasibility of internet interventions in clinical practice is, however, still scarce. Especially studies with a focus on the patient, regarding usability of interventions and digital health literacy skills, are lacking.

Objective:

To assess the usability of a specific ICBT for chronic pain and the relation between usability outcomes and respectively age, educational level and digital health literacy skills. The aims are (1) to gain an overview of what changes are needed in the program for sufficient usability and (2) to explore how ICBT can be utilized among different sub groups of patients.

Methods:

A qualitative observational study was set up in which usability was tested using performance tasks in the ICBT program. Usability was operationalized as the number of tasks that could be completed, and the type and number of problems that occurred while doing so. The performance tasks were set up to measure six different digital skills: (1) operating the computer and internet browser, (2) navigation and orientation, (3) utilizing search strategies, (4) evaluating relevance of content, (5) adding personal content, and (6) protecting and respecting privacy. Participants were asked to think aloud while performing the tasks, and screen activities and webcam recordings were captured. Data was coded using inductive analysis by two independent researchers. A survey was used to measure socio-demographics and digital health literacy.

Results:

32 patients participated, with a mean age of 49.9 years. All performance tasks except one, could be completed independently by more than 50% of the participants. On an operational, navigation and search level, participants struggled most with logging in, logging out and finding specific parts of the intervention. Regarding evaluating the relevance and adding content to the program, half of the sample experienced problems to some extent. Usability correlated moderately with age and digital health literacy skills, but not with educational level.

Conclusions:

The results provide insight into what is essential for proper usability regarding the design of an ICBT program, taking into account variations in age, educational level and digital health literacy. Furthermore, the results provide insight into what type of support is needed by patients to properly use the intervention. Relations with age and digital health literacy suggest tailoring of needed support between subgroups, ranging from no extra support (only online feedback, as intended), practical support (an extra usability introduction session) and blended care (combined face-to-face sessions throughout the therapy).