JMIR Publications

ABSTRACT

Background:

People seeking abortion in early pregnancy have the choice between medication and procedural options for care. The choice is preference-sensitive – there is no clinically superior option and the choice depends on what matters most to the individual patient. Patient decision aids (PtDAs) are shared decision-making tools that support people to make informed, values-aligned health care choices.

Objective:

We aimed to develop and evaluate the usability of a web-based PtDA for the Canadian context, where abortion care is publicly funded and available without legal restriction.

Methods:

We used a systematic, user-centred design approach guided by principles of integrated knowledge translation. We first developed a prototype using available evidence for abortion seekers’ decisional needs and the risks, benefits, and consequences of each option. We then refined the prototype through think-aloud interviews with participants at risk of unintended pregnancy (“patient” participants). Interviews were audio-recorded and documented through field notes. Finally, we conducted an online survey of patients and healthcare providers involved with abortion care, which included the System Usability Scale. We used content analysis to identify usability issues described in the field notes and open-ended survey questions, and descriptive statistics to summarize demographic information and close-ended survey responses.

Results:

A total of 61 individuals participated in the study. Eleven patients participated in think-aloud interviews. Overall, the response to the PtDA was positive; however, the content analysis identified issues related to the design, language, and information about the process and experience of obtaining abortion care. In response, we adapted the PtDA into an interactive website and revised it to include consistent and plain language, additional information (e.g. pain experience narratives), and links to additional resources on how to find an abortion provider. Twenty-five patients and 25 health care providers completed the survey. The mean System Usability Scale score met the threshold for good usability among both patient and health care provider participants. Most participants felt that the PtDA was user friendly (patients: n=25, 100%; health care providers: n=22, 88%), was not missing information (patients: n=21, 84%; health care providers: n=18, 72%), and that it was appropriate for patients to complete the PtDA before a consultation (patients: n=23, 92%; health care providers: n=23, 92%). Open ended responses focused on improving usability by reducing the length of the PtDA and making the website more mobile-friendly.

Conclusions:

We systematically designed the PtDA to address an unmet need to support informed, values-aligned decision making about method of abortion. The design process responded to a need identified by potential users, and addressed unique sensitivities related to reproductive health decision-making.