title: Usability Testing of an Internet-Based e-Counseling Platform for Adults With Chronic Heart Failure.
abstract: BACKGROUND
  Chronic heart failure (CHF) is a major cause of hospitalization and mortality. In order to maintain heart function and quality of life, patients with CHF need to follow recommended self-care guidelines (ie, eating a heart healthy diet, exercising regularly, taking medications as prescribed, monitoring their symptoms, and living a smoke-free life). Yet, adherence to self-care is poor. We have developed an Internet-based e-Counseling platform, Canadian e-Platform to Promote Behavioral Self-Management in Chronic Heart Failure (CHF-CePPORT), that aims to improve self-care adherence and quality of life in people with CHF. Before assessing the efficacy of this e-platform in a multisite, double-blind, randomized controlled trial, we evaluated the usability of the prototype website.
  
  
  OBJECTIVE
  The objective of the study was to assess the usability of the CHF-CePPORT e-Counseling platform in terms of navigation, content, and layout.
  
  
  METHODS
  CHF patients were purposively sampled from the Heart Function Clinic at the Peter Munk Cardiac Center, University Health Network, to participate in this study. We asked the consented participants to perform specific tasks on the website. These tasks included watching self-help videos and reviewing content as directed. Their interactions with the website were captured using the "think aloud" protocol. After completing the tasks, research personnel conducted a semi-structured interview with each participant to assess their experience with the website. Content analysis of the transcripts from the "think aloud" sessions and the interviews was conducted to identify themes related to navigation, content, and layout of the website. Descriptive statistics were used to summarize the satisfaction data.
  
  
  RESULTS
  A total of 7 men and women (ages 39-77) participated in 2 iterative rounds of testing. Overall, all participants were very satisfied with the content and layout of the website. They reported that the content was helpful to their management of CHF and that it reflected their experiences in coping with CHF. The layout was professional and friendly. The use of videos made the learning process entertaining. However, they experienced many navigation errors in the first round of testing. For example, some participants were not sure how to navigate across a series of Web pages. Based on the experiences that were reported in the first round, we made several changes to the navigation structure. This included using large navigation buttons to direct users to each section and providing tutorial videos to familiarize users with our website. We assessed whether these changes improved user navigation in the second round of testing. The major finding is that participants made fewer navigation errors and they did not identify any new problems.
  
  
  CONCLUSIONS
  We found evidence to support the usability of our CHF-CePPORT e-Counseling platform. Our findings highlight the importance of a clear and easy-to-follow navigation structure on user experience.
authors.affiliation: Cardiac eHealth, Peter Munk Cardiac Centre, University Health Network, Toronto, ON, Canada. ada.payne@uhnresearch.ca.
authors.forename: Ada Ym
authors.identifier: http://orcid.org/0000-0002-2475-3379
authors.initials: AY
authors.lastname: Payne
authors.forename: Jelena
authors.identifier: http://orcid.org/0000-0003-3089-0043
authors.initials: J
authors.lastname: Surikova
authors.forename: Sam
authors.identifier: http://orcid.org/0000-0003-2364-7774
authors.initials: S
authors.lastname: Liu
authors.forename: Heather
authors.identifier: http://orcid.org/0000-0003-4384-3027
authors.initials: H
authors.lastname: Ross
authors.forename: Teodora
authors.identifier: http://orcid.org/0000-0001-9774-6973
authors.initials: T
authors.lastname: Mechetiuc
authors.forename: Robert P
authors.identifier: http://orcid.org/0000-0002-5170-9840
authors.initials: RP
authors.lastname: Nolan
keywords: chronic heart failure; e-counseling; self-care behaviors; usability assessment