JMIR Publications

ABSTRACT

Background:

Dementia is a widespread disease that currently affects more than 55 million people worldwide. (Digital) screening instruments are one way to increase diagnosis rates. Developing an app for older adults presents several challenges, both technical and social. In order to make the app user-friendly, feedback from potential future end-users is crucial during this development process.

Objective:

Establish a user centred design process for the development of digiDEM-SCREEN, a user-friendly app to support early identification of persons with slight symptoms of dementia.

Methods:

This research utilises qualitative and quantitative methods and involves three key stakeholder groups: the digiDEM research team, the software development team and the target user group (older adults (≥ 65 years) with and without cognitive impairments). The development of the screening app is based on an already existing and scientifically analysed screening test (Self-Administered Tasks Uncovering Risk of Neurodegeneration (SATURN)). An initial prototype based on recommendations for mobile health applications and the teams' experiences was developed. The prototype was tested in several iterations by various end users and continuously improved. The app's usability is evaluated using the System Usability Scale (SUS), and verbal feedback by the end users is obtained by the think-aloud method.

Results:

The translation process during test development took linguistic and cultural aspects into account. The texts were also adapted to the German-speaking context. Additional instructions were developed and supplemented. The test was administered using different randomisation options to minimise learning effects. digiDEM-SCREEN was developed as a tablet and smartphone application. In the first focus group discussion, the most significant criticism was identified and corrected by the developers in the next version. Based on the iterative improvement process only minor issues needed to be addressed after the final focus group discussion. The SUS score increased with each version (V1: 72.5; V2: 83.13), while the verbal feedback from end users also improved.

Conclusions:

The development of digiDEM-SCREEN serves as an excellent example of the importance of involving experts and potential end users in the design and development process of health apps. A close collaboration with end users leads to products that not only meet current standards but also address the actual needs and expectations of users. This is also a crucial step toward promoting broader adoption of such digital tools. This research highlights the significance of a user-centred design approach, allowing content, text, and design to be optimally tailored to the needs of the target audience. From these findings, it can be concluded that future projects in the field of health apps would also benefit from a similar approach.