title: Critical design elements of e-health applications for users with severe mental illness: singular focus, simple architecture, prominent contents, explicit navigation, and inclusive hyperlinks.
abstract: OBJECTIVE
  E-health applications are becoming integral components of general medical care delivery models and emerging for mental health care. Few exist for treatment of those with severe mental illness (SMI). In part, this is due to a lack of models to design such technologies for persons with cognitive impairments and lower technology experience. This study evaluated the effectiveness of an e-health design model for persons with SMI termed the Flat Explicit Design Model (FEDM).
  
  
  METHODS
  Persons with schizophrenia (n = 38) performed tasks to evaluate the effectiveness of 5 Web site designs: 4 were prominent public Web sites, and 1 was designed according to the FEDM. Linear mixed-effects regression models were used to examine differences in usability between the Web sites. Omnibus tests of between-site differences were conducted, followed by post hoc pairwise comparisons of means to examine specific Web site differences when omnibus tests reached statistical significance.
  
  
  RESULTS
  The Web site designed using the FEDM required less time to find information, had a higher success rate, and was rated easier to use and less frustrating than the other Web sites. The home page design of one of the other Web sites provided the best indication to users about a Web site's contents. The results are consistent with and were used to expand the FEDM.
  
  
  CONCLUSIONS
  The FEDM provides evidence-based guidelines to design e-health applications for person with SMI, including: minimize an application's layers or hierarchy, use explicit text, employ navigational memory aids, group hyperlinks in 1 area, and minimize the number of disparate subjects an application addresses.
authors.affiliation: Department of Critical Care Medicine, Clinical and Translational Sciences Institute, University of Pittsburgh, Pittsburgh, PA; Mental Illness Research, Education and Clinical Center (MIRECC), Department of Veterans Affairs Medical Center, Pittsburgh, PA; Rotondi@pitt.edu.
authors.forename: Armando J
authors.initials: AJ
authors.lastname: Rotondi
authors.affiliation: School of Social Work, Psychiatry, and Clinical and Translational Sciences Institute, University of Pittsburgh, Pittsburgh, PA;
authors.forename: Shaun M
authors.initials: SM
authors.lastname: Eack
authors.affiliation: Mental Illness Research, Education and Clinical Center (MIRECC), and Center for Health Equity Research (CHERP), Department of Veterans Affairs Medical Center, Pittsburgh, PA;
authors.forename: Barbara H
authors.initials: BH
authors.lastname: Hanusa
authors.affiliation: School of Information Sciences, University of Pittsburgh, Pittsburgh, PA;
authors.forename: Michael B
authors.initials: MB
authors.lastname: Spring
authors.affiliation: VA Pittsburgh Mental Illness Research Education and Clinical Centers (MIRECC), Department of Veterans Affairs Medical Center, Pittsburgh, PA; Western Psychiatric Institute and Clinic (WPIC), University of Pittsburgh, Pittsburgh, PA.
authors.forename: Gretchen L
authors.initials: GL
authors.lastname: Haas
mesh_terms: D000328:Adult; D005260:Female; D006801:Humans; D020407:Internet / Q000592:standards*; D008297:Male; D008875:Middle Aged; D010353:Patient Education as Topic / Q000592:standards*; D012559:Schizophrenia / Q000534:rehabilitation*; D012984:Software / Q000592:standards*; D017216:Telemedicine / Q000592:standards*
keywords: Web site; Web site design; Web site usability; e-mental health; schizophrenia