A self-administered dietary assessment website for use in primary health care: usability testing and evaluation

Background: A dietary assessment website for use in the primary health care setting has been developed. The website allows patients, referred from their general practitioners (GP), to self-report their dietary intake. Data from the website feeds to a dietitian who develops individualised dietary advice for the patient. Aim: The aim of this article is to describe the usability testing of the dietary assessment website with its potential users. Methods: Testing was broken into two phases. Forty-two free-living adults with metabolic syndrome volunteered, 17 completed phase 1 and 10 completed phase 2, with a 64% rate of completion. Phase 1 participants spoke aloud as they progressed through the self-administered dietary assessment website under researcher observation. Observed difficulties in website use and need for assistance was recorded and the website underwent modifications between phases. Only four participants in phase 1 required large amounts of assistance. Phase 2 participants progressed through the website without observation or using the think-aloud protocol. This simulated the environment in the GP practice within which the website was to be implemented. All participants completed pre- and post-use questionnaires assessing feelings toward use, computer experience and problems encountered. Findings: Questionnaires were thematically analysed for relationships between website use and participant feelings. Time taken to use the website was recorded automatically. Website features were grouped into ‘action classes’, for example selecting food items, and times taken were calculated for each class. Comparisons (t-tests) were made between the action classes for the two phases. Average time taken to select the food items was 31 min and 24 min for phases 1 and 2, respectively. Total time taken was approximately 1 h and varied by 4 min between phases. Time taken to complete the dietary assessment was comparable to a face-to-face diet history with a dietitian. The website was found to be highly user friendly with little assistance being required for most levels of computer experience. Dietary management may be overlooked by GPs, yet by offering different methods of accessing dietitians, management may improve.

[1]  John R. Talburt.  Proceedings of the 8th Annual International Conference on Systems Documentation, SIGDOC 1990, Little Rock, Arkansas, USA, October 31 - November 2, 1990 , 1990, SIGDOC.

[2]  Ulrich A Müller,et al.  Evaluation of a computer based interactive diabetes education program designed to train the estimation of the energy or carbohydrate contents of foods. , 2002, Patient education and counseling.

[3]  D. Nieman,et al.  Comparison of eight microcomputer dietary analysis programs with the USDA Nutrient Data Base for Standard Reference. , 1995, Journal of the American Dietetic Association.

[4]  Nutrition Evaluation Scale System reduces time and labor in recording quantitative dietary intake. , 1990, Journal of the American Dietetic Association.

[5]  Menno D. T. de Jong,et al.  Retrospective vs. concurrent think-aloud protocols: Testing the usability of an online library catalogue , 2003, Behav. Inf. Technol..

[6]  A. Heath,et al.  The relative validity of a computerized food frequency questionnaire for estimating intake of dietary iron and its absorption modifiers , 2000, European Journal of Clinical Nutrition.

[7]  L. Faulkner.  Beyond the five-user assumption: Benefits of increased sample sizes in usability testing , 2003, Behavior research methods, instruments, & computers : a journal of the Psychonomic Society, Inc.

[8]  J. Lehman,et al.  Computer-based simulations enhance clinical experience of dietetics interns. , 2000, Journal of the American Dietetic Association.

[9]  Mark Simpson.  How usability testing can aid the development of online documentation , 1990, SIGDOC '90.

[10]  Julie A. Jacko,et al.  The effects of multimodal feedback on older adults' task performance given varying levels of computer experience , 2004, Behav. Inf. Technol..

[11]  James G. Phillips,et al.  Cursor Orientation and Computer Screen Positioning Movements , 2001, Hum. Factors.

[12]  Fred D. Davis.  User Acceptance of Information Technology: System Characteristics, User Perceptions and Behavioral Impacts , 1993, Int. J. Man Mach. Stud..

[13]  Ann Lantz,et al.  Design Versus design-From the Shaping of Products to the Creation of User Experiences , 2003, Int. J. Hum. Comput. Interact..

[14]  Fred D. Davis,et al.  A critical assessment of potential measurement biases in the technology acceptance model: three experiments , 1996, Int. J. Hum. Comput. Stud..

[15]  Sally Dillow,et al.  Using think-aloud protocols in formative evaluation of interactive voice response systems , 1997, Int. J. Speech Technol..

[16]  Joseph A. Diaz,et al.  Patient attitudes toward using computers to improve health services delivery , 2002, BMC health services research.

[17]  C. Wells,et al.  Altruism as a reason for participation in clinical trials was independently associated with adherence. , 2005, Journal of clinical epidemiology.

[18]  Fred D. Davis,et al.  Development and Test of a Theory of Technological Learning and Usage , 1992 .

[19]  Fred D. Davis.  Perceived Usefulness, Perceived Ease of Use, and User Acceptance of Information Technology , 1989, MIS Q..

[20]  Monique W. M. Jaspers,et al.  The think aloud method: a guide to user interface design , 2004, Int. J. Medical Informatics.