Evaluation of the Digital Alzheimer Center: Testing Usability and Usefulness of an Online Portal for Patients with Dementia and Their Carers

Background Dementia is a progressive and highly disabling neurodegenerative disease that will likely become highly prevalent in the future due to the globally aging population. To improve health care efficiency and quality for dementia care, eHealth could help with, for example, an online portal, such as the Digital Alzheimer Center (DAC) of the Vrije Universiteit Medical Center Amsterdam. It provides up-to-date disease information, peer-to-peer contact, and methods for contacting the hospital and health professionals. Objective We aimed to investigate the usability and usefulness of the DAC for patients with dementia and carers to get insight into the feasibility and value of this eHealth app in dementia care and to recommend potential improvements. Methods A descriptive study among patients, carers, and health care professionals was performed. Mixed methods were used, consisting of observations (n=10, 4 people with dementia, 6 carers), an online survey (n=287; 88 patients, 199 carers), and semistructured interviews (n=18; 6 patients, 6 carers, 6 health care professionals). During the observations, participants performed a set of five different prescribed tasks on the portal. Speed, number of errors, and navigation were noted. The online survey aimed to assess users’ opinions on the portal’s usability and usefulness. Semistructured interviews were conducted in a subsample of patients, carers, and health care professionals to gain more in-depth information. Results In the usability assessment, eight categories of errors were distinguished, of which three were of critical, two of medium, and three of low severity. In the survey, 45% (40/88) of the patients and 53% (105/199) of the carers indicated they used the portal. In all, 33% (12/36) of patients and 61% (62/102) of carers found it easy to learn to work with the portal. Most considered the DAC generally useful: 65% (17/26) of patients and 78% (67/86) of carers found the DAC useful, especially for understanding dementia (patients: 64%, 16/25; carers: 62%, 53/86). In the semistructured interviews, the site was generally rated positively on usability and usefulness and being well designed. People with dementia and carers indicated it helped them to understand and deal with dementia. Conclusions To our knowledge, this is the first study investigating the usability and usefulness of an Internet portal especially designed for people with dementia and their carers. An online patient portal could be a useful means to help to support patients and carers in dealing with dementia: the majority of users positively evaluated usability and usefulness of the portal, and appreciated the information on it. However, only a minority of patients found it easy to work with the portal. Good design and frequent usability testing is essential to offer a good online portal.

[1]  V. Braun,et al.  Using thematic analysis in psychology , 2006 .

[2]  Elske Ammenwerth,et al.  The Impact of Electronic Patient Portals on Patient Care: A Systematic Review of Controlled Trials , 2012, Journal of medical Internet research.

[3]  M. Carlsson,et al.  Staff perceptions of job satisfaction and life situation before and 6 and 12 months after increased information technology support in dementia care. , 2005, Journal of telemedicine and telecare.

[4]  Theodoros N. Arvanitis,et al.  Patients' online access to their electronic health records and linked online services: a systematic review in primary care. , 2015, The British journal of general practice : the journal of the Royal College of General Practitioners.

[5]  Carolyn Snyder,et al.  Web Site Usability: A Designer's Guide , 1997 .

[6]  C. Nugent,et al.  Usability of a new electronic assistive device for community-dwelling persons with mild dementia , 2012, Aging & mental health.

[7]  Chris Barker,et al.  The Effectiveness of an Internet Support Forum for Carers of People With Dementia: A Pre-Post Cohort Study , 2014, Journal of medical Internet research.

[8]  R. Morrell Designing Web-Based Health Information for Older Adults: Visual Considerations and Design Directives , 2001 .

[9]  John Bond,et al.  The worldwide economic impact of dementia 2010 , 2013, Alzheimer's & Dementia.

[10]  F. Verhey,et al.  A systematic review of Internet‐based supportive interventions for caregivers of patients with dementia , 2014, International journal of geriatric psychiatry.

[11]  R. Hofmann-Wellenhof,et al.  Mobile teledermatology for skin tumour screening: diagnostic accuracy of clinical and dermoscopic image tele‐evaluation using cellular phones , 2011, The British journal of dermatology.

[12]  C. Nugent,et al.  Review of ICT-based services for identified unmet needs in people with dementia , 2007, Ageing Research Reviews.

[13]  Johan Burisch,et al.  E-health empowers patients with ulcerative colitis: a randomised controlled trial of the web-guided ‘Constant-care’ approach , 2010, Gut.

[14]  R. Dröes,et al.  Dementia-Related and Other Factors to Be Taken into Account When Developing ICT Support for People with Dementia – Lessons from Field Trials , 2010 .

[15]  M. Vollenbroek-Hutten,et al.  Video teleconsultation service: who is needed to do what, to get it implemented in daily care? , 2010, Telemedicine journal and e-health : the official journal of the American Telemedicine Association.

[16]  L. Clare,et al.  Improving website accessibility for people with early-stage dementia: A preliminary investigation , 2005, Aging & mental health.

[17]  Joseph Sharit,et al.  Factors influencing use of an e-health website in a community sample of older adults , 2013, J. Am. Medical Informatics Assoc..

[18]  G Eysenbach,et al.  What is e-health? , 2001, Encyclopedia of Social Network Analysis and Mining. 2nd Ed..

[19]  C. Chronaki,et al.  European citizens' use of E-health services: A study of seven countries , 2007, BMC public health.

[20]  Sri Hastuti Kurniawan,et al.  Increasing the Usability of Online Information for Older Users: A Case Study in Participatory Design , 2000, Int. J. Hum. Comput. Interact..

[21]  Jakob Nielsen,et al.  A mathematical model of the finding of usability problems , 1993, INTERCHI.

[22]  E. Marziali,et al.  Clinical Practice Standards and Ethical Issues Applied to a Virtual Group Intervention for Spousal Caregivers of People with Alzheimer's , 2007, Social work in health care.

[23]  Ian H. Witten,et al.  Web usability and age: how design changes can improve performance , 2002, CUU '03.

[24]  Martina Ziefle,et al.  How older adults meet complexity: Aging effects on the usability of different mobile phones , 2005, Behav. Inf. Technol..

[25]  A. Sheikh,et al.  The use of global positional satellite location in dementia: a feasibility study for a randomised controlled trial , 2014, BMC Psychiatry.

[26]  Kathleen M Griffiths,et al.  Review of randomised controlled trials of Internet interventions for mental disorders and related conditions , 2006 .

[27]  N. Nijhof,et al.  Ehealth for people with dementia in home-based and residential care , 2008 .

[28]  Constantine Stephanidis,et al.  Human-Computer Interaction : Theory and Practice (part 2), Volume 2 , 2003 .

[29]  Chauncey E. Wilson,et al.  The Usability Engineering Framework for Product Design and Evaluation , 1997 .

[30]  R. Dröes,et al.  Participation of end users in the design of assistive technology for people with mild to severe cognitive problems; the European Rosetta project , 2014, International Psychogeriatrics.

[31]  Aziz Sheikh,et al.  The use of global positioning systems in promoting safer walking for people with dementia , 2013, Journal of telemedicine and telecare.

[32]  Henry Brodaty,et al.  Meta‐Analysis of Psychosocial Interventions for Caregivers of People with Dementia , 2003, Journal of the American Geriatrics Society.

[33]  S. Varma,et al.  Mobile teledermatology for skin tumour screening , 2011, The British journal of dermatology.

[34]  Kenneth D. Mandl,et al.  Mychildren's: Integration of a Personally Controlled Health Record with a Tethered Patient Portal for a Pediatric and Adolescent Population , 2009, AMIA.

[35]  Jakob Nielsen,et al.  Usability engineering , 1997, The Computer Science and Engineering Handbook.

[36]  Peter Robinson,et al.  Perception and haptics: towards more accessible computers for motion-impaired users , 2001, PUI '01.

[37]  Chiew Tong Lau,et al.  Remote health monitoring using mobile phones and Web services. , 2010, Telemedicine journal and e-health : the official journal of the American Telemedicine Association.

[38]  Panayiotis Zaphiris,et al.  Research-derived web design guidelines for older people , 2005, Assets '05.

[39]  J. Jacko,et al.  The human-computer interaction handbook: fundamentals, evolving technologies and emerging applications , 2002 .

[40]  Joris van de Klundert,et al.  How outcomes are achieved through patient portals: a realist review , 2014, J. Am. Medical Informatics Assoc..

[41]  R. Dröes,et al.  The electronic, personalizable Rosetta system for dementia care: exploring the user-friendliness, usefulness and impact , 2016, Disability and rehabilitation. Assistive technology.

[42]  C. Nugent,et al.  Web-Based STAR E-Learning Course Increases Empathy and Understanding in Dementia Caregivers: Results from a Randomized Controlled Trial in the Netherlands and the United Kingdom , 2015, Journal of medical Internet research.