title: The Usability of Diabetes MAP: A Web-delivered Intervention for Improving Medication Adherence.
abstract: BACKGROUND
  Web-delivered interventions are a feasible approach to health promotion. However, if a website is poorly designed, difficult to navigate, and has technical bugs, it will not be used as intended. Usability testing prior to evaluating a website's benefits can identify barriers to user engagement and maximize future use.
  
  
  OBJECTIVE
  We developed a Web-delivered intervention called Diabetes Medication Adherence Promotion (Diabetes MAP) and used a mixed-methods approach to test its usability prior to evaluating its efficacy on medication adherence and glycemic control in a randomized controlled trial.
  
  
  METHODS
  We recruited English-speaking adults with type 2 diabetes mellitus (T2DM) from an academic medical center who were prescribed diabetes medications. A trained research assistant administered a baseline survey, collected medical record information, and instructed participants on how to access Diabetes MAP. Participants were asked to use the site independently for 2 weeks and to provide survey and/or focus group feedback on their experience. We analyzed survey data descriptively and qualitative data thematically to identify participants' favorable and unfavorable experiences, characterize usability concerns, and solicit recommendations for improving Diabetes MAP.
  
  
  RESULTS
  Enrolled participants (N=32) were an average of 51.7 ± 11.8 years old, 66% (21/32) female, 60% (19/32) non-Hispanic White, 88% (28/32) had more than 12 years of education, half had household incomes over $50,000, and 78% (25/32) were privately insured. Average duration of diagnosed diabetes was 7.8 ± 6.3 years, average A1c was 7.4 ± 2.0, and 38% (12/32) were prescribed insulin. Of enrolled participants, 91% (29/32) provided survey and/or focus group feedback about Diabetes MAP. On the survey, participants agreed website information was clear and easy to understand, but in focus groups they reported navigational challenges and difficulty overcoming user errors (eg, entering data in an unspecified format). Participants also reported difficulty accessing the site and, once accessed, using all of its features. Participants recommended improving the site's user interface to facilitate quick, efficient access to all features and content.
  
  
  CONCLUSIONS
  Adults with T2DM rated the Diabetes MAP website favorably on surveys, but focus groups gave more in-depth feedback on the user experience (eg, difficulty accessing the site, maximizing all of the site's features and content, and recovering from errors). Appropriate usability testing methods ensure Web-delivered interventions work as intended and any benefits are not diminished by usability challenges.
authors.affiliation: Department of Medicine, Vanderbilt University Medical Center, Nashville, TN, United States.
authors.forename: Lyndsay A
authors.identifier: http://orcid.org/0000-0002-7304-5643
authors.initials: LA
authors.lastname: Nelson
authors.forename: Magaela C
authors.identifier: http://orcid.org/0000-0001-8140-6878
authors.initials: MC
authors.lastname: Bethune
authors.forename: Andrea E
authors.identifier: http://orcid.org/0000-0002-2252-1152
authors.initials: AE
authors.lastname: Lagotte
authors.forename: Chandra Y
authors.identifier: http://orcid.org/0000-0002-7668-028X
authors.initials: CY
authors.lastname: Osborn
keywords: Intervention; Medication Adherence; Type 2 Diabetes Mellitus; Usability Testing; Website