title: An interactive, bilingual touch screen program to promote breastfeeding among Hispanic rural women: usability study.
abstract: BACKGROUND
  Computer technology can be effectively used to educate patients and improve knowledge and attitudes, leading to healthier behavior. Among rural women, breastfeeding outcomes seem to be worst compared to women living in urban areas. The implementation of a bilingual computer mediated health education program to disseminate information and improve outcomes among users with low literacy levels has proven to be successful.
  
  
  OBJECTIVE
  The objective of this pilot study was to examine the usability of an interactive, bilingual touch screen computer-based educational program to promote breastfeeding practices among Hispanic women living in rural settings.
  
  
  METHODS
  A convenience sample of 10 Hispanic rural women at the Regional West Medical Center (RWMC), Scottsbluff was enrolled during May 2013. Information about this cross-sectional study was made available through the flyers at the RWMC. A brief introduction of the prototype was given and study subjects were then asked to complete a predefined set of tasks by interacting with the prototype. Users were assigned 6 tasks and information was gathered about the time taken to complete the tasks, number of attempts, and if assistance was needed. Notes and test sessions were audiotaped. Usability assessment was performed using the System Usability Scale (SUS).
  
  
  RESULTS
  The mean age of the study participants was 28 years (SD 3.6), the majority of them had 12 or more years of education (90%, 9/10), and 60% (6/10) had breastfed less than 6 months. There were 90% (9/10) of the study participants that had no prior history of taking prenatal classes and 80% (8/10) that did not intend to take any prenatal classes in the future. The average SUS scores were 90 and SD was 10.5. There were three participants that had average SUS scores of 100, followed by scores of 97.5 (1/10), 95 (1/10), 87.5 (1/10), 85 (2/10), 82.5 (1/10), and one participant had a score of 67.5 (1/10). No assistance was needed to complete any of the tasks.
  
  
  CONCLUSIONS
  The study participants were able to navigate through the multimedia program with ease and obtain relevant breastfeeding related health information. The interactive, touch screen computer-based breastfeeding program had high acceptance among 10 Hispanic women living in rural settings.
authors.affiliation: Center for Global Health and Development, College of Public Health, University of Nebraska Medical Center, Omaha, NE, United States. ashish.joshi@unmc.edu.
authors.forename: Ashish
authors.initials: A
authors.lastname: Joshi
authors.forename: Susan
authors.initials: S
authors.lastname: Wilhelm
authors.forename: Trina
authors.initials: T
authors.lastname: Aguirre
authors.forename: Kate
authors.initials: K
authors.lastname: Trout
authors.forename: Chioma
authors.initials: C
authors.lastname: Amadi
keywords: breastfeeding; computer; education; evaluation; usability