title: Usability evaluation and adaptation of the e-health Personal Patient Profile-Prostate decision aid for Spanish-speaking Latino men.
abstract: BACKGROUND
  The Personal Patient Profile-Prostate (P3P), a web-based decision aid, was demonstrated to reduce decisional conflict in English-speaking men with localized prostate cancer early after initial diagnosis. The purpose of this study was to explore and enhance usability and cultural appropriateness of a Spanish P3P by Latino men with a diagnosis of prostate cancer.
  
  
  METHODS
  P3P was translated to Spanish and back-translated by three native Spanish-speaking translators working independently. Spanish-speaking Latino men with a diagnosis of localized prostate cancer, who had made treatment decisions in the past 24 months, were recruited from two urban clinical care sites. Individual cognitive interviews were conducted by two bilingual research assistants as each participant used the Spanish P3P. Notes of user behavior, feedback, and answers to direct questions about comprehension, usability and perceived usefulness were analyzed and categorized.
  
  
  RESULTS
  Seven participants with a range of education levels identified 25 unique usability issues in navigation, content comprehension and completeness, sociocultural appropriateness, and methodology. Revisions were prioritized to refine the usability and cultural and linguistic appropriateness of the decision aid.
  
  
  CONCLUSIONS
  Usability issues were discovered that are potential barriers to effective decision support. Successful use of decision aids requires adaptation and testing beyond translation. Our findings led to revisions further refining the usability and linguistic and cultural appropriateness of Spanish P3P.
authors.affiliation: Biobehavioral Nursing and Health Systems, University of Washington, Seattle, WA, USA. donnalb@uw.edu.|The Phyllis F. Cantor Center, Dana-Farber Cancer Institute, Boston, MA, USA. donnalb@uw.edu.
authors.forename: Donna L
authors.initials: DL
authors.lastname: Berry
authors.affiliation: The Phyllis F. Cantor Center, Dana-Farber Cancer Institute, Boston, MA, USA.
authors.forename: Barbara
authors.initials: B
authors.lastname: Halpenny
authors.affiliation: The Phyllis F. Cantor Center, Dana-Farber Cancer Institute, Boston, MA, USA.
authors.forename: Jaclyn L F
authors.initials: JLF
authors.lastname: Bosco
authors.affiliation: Joan C. Edwards School of Medicine- Marshall University, Huntington, WV, USA.
authors.forename: John
authors.initials: J
authors.lastname: Bruyere
authors.affiliation: Department of Urology, Emory University School of Medicine, Atlanta, USA.
authors.forename: Martin G
authors.initials: MG
authors.lastname: Sanda
mesh_terms: D003661:Decision Support Techniques; D006630:Hispanic or Latino; D006801:Humans; D008297:Male; D011471:Prostatic Neoplasms / Q000628:therapy*; D017216:Telemedicine; D014175:Translating