title: Adapting a weight management tool for Latina women: a usability study of the Veteran Health Administration's MOVE!23 tool.
abstract: Obesity disproportionately affects Latina women, but few targeted, technology-assisted interventions that incorporate tailored health information exist for this population. The Veterans Health Administration (VHA) uses an online weight management tool (MOVE!23) which is publicly available, but was not designed for use in non-VHA populations.
  
  
  
  We conducted a qualitative study to determine how interactions between the tool and other contextual elements impacted task performance when the target Latina users interacted with MOVE!23. We sought to identify and classify specific facilitators and barriers that might inform design changes to the tool and its context of use, and in turn promote usability. Six English-speaking, adult Latinas were recruited from an inner city primary care clinic and a nursing program at a local university in the United States to engage in a "Think-Aloud" protocol while using MOVE!23. Sessions were recorded, transcribed, and coded to identify interactions between four factors that contribute to usability (Tool, Task, User, Context).
  
  
  
  Five themes influencing usability were identified: Technical Ability and Technology Preferences; Language Confusion and Ambiguity; Supportive Tool Design and Facilitator Guidance; Relevant Examples; and Personal Experience. Features of the tool, task, and other contextual factors failed to fully support participants at times, impeding task completion. Participants interacted with the tool more readily when its language was familiar and content was personally relevant. When faced with ambiguity and uncertainty, they relied on the tool's visual cues and examples, actively sought relevant personal experiences, and/or requested facilitator support.
  
  
  
  The ability of our participants to successfully use the tool was influenced by the interaction of individual characteristics with those of the tool and other contextual factors. We identified both tool-specific and context-related changes that could overcome barriers to the use of MOVE!23 among Latinas. Several general considerations for the design of eHealth tools are noted.
authors.affiliation: Division of General Internal Medicine, Montefiore Medical Center, Bronx, NY, 10467, USA.
authors.forename: Hector R
authors.initials: HR
authors.lastname: Perez
authors.affiliation: Program for Medical Education and Technology, NYU School of Medicine, New York, NY, 10016, USA.
authors.forename: Michael W
authors.initials: MW
authors.lastname: Nick
authors.affiliation: Research, VA NY Harbor Healthcare System, 423 East 23rd Street, 15161N, New York, NY, 10010, USA.|Medicine, NYU School of Medicine, New York, NY, 10016, USA.
authors.forename: Katrina F
authors.initials: KF
authors.lastname: Mateo
authors.affiliation: NYU College of Nursing, New York, NY, 10003, USA.
authors.forename: Allison
authors.initials: A
authors.lastname: Squires
authors.affiliation: Research, VA NY Harbor Healthcare System, 423 East 23rd Street, 15161N, New York, NY, 10010, USA.|Population Health, NYU School of Medicine, New York, NY, 10016, USA.
authors.forename: Scott E
authors.initials: SE
authors.lastname: Sherman
authors.affiliation: Medicine, NYU School of Medicine, New York, NY, 10016, USA.
authors.forename: Adina
authors.initials: A
authors.lastname: Kalet
authors.affiliation: Research, VA NY Harbor Healthcare System, 423 East 23rd Street, 15161N, New York, NY, 10010, USA. Melanie.Jay@nyumc.org.|Medicine, NYU School of Medicine, New York, NY, 10016, USA. Melanie.Jay@nyumc.org.|Population Health, NYU School of Medicine, New York, NY, 10016, USA. Melanie.Jay@nyumc.org.
authors.forename: Melanie
authors.initials: M
authors.lastname: Jay
mesh_terms: D000328:Adult; D005260:Female; D006630:Hispanic or Latino; D006801:Humans; D008491:Medical Informatics Applications; D008875:Middle Aged; D009765:Obesity / Q000628:therapy*; D010342:Patient Acceptance of Health Care; D036301:Qualitative Research; D014481:United States; D014493:United States Department of Veterans Affairs; D055815:Young Adult
keywords: Behavioral medicine; Intervention research; Latino; Obesity; Qualitative research; Usability testing