282 Usability testing of an online version of the Strengthening and Stretching for Rheumatoid Arthritis of the Hand (SARAH) programme for people with rheumatoid arthritis

Abstract

Background: The Strengthening and Stretching for Rheumatoid Arthritis of the Hand (SARAH) programme is a tailored 12-week progressive hand and arm exercise programme for people with hand problems due to rheumatoid arthritis (RA). The programme was shown to be clinically and cost effective in a large clinical trial and is now recommended in the NICE guidelines for RA in adults. The preliminary version of mySARAH was developed based on the feedback from patient volunteers, the SARAH trial team, and information technology experts. mySARAH includes online assessment and exercise sessions, exercise videos, downloadable materials, self-monitoring tools, technical support and personalised exercise planners, calendars, and email reminders. The purpose of this study was to evaluate the usability of mySARAH in people with RA. Methods: Guided by previous studies that 95% usability issues can be identified with a minimum of nine participants, we aimed to recruit 10 volunteers with RA. Usability of mySARAH was evaluated in two iterative cycles following: think aloud protocol; subjective reports on the usefulness, ease of use and confidence in using mySARAH and evaluation of execution of exercises. The computer system usability (CSU) questionnaire was used to evaluate the usability of the programme on a 7-point Likert scale (1 = strongly disagree to 7 = strongly agree). Five-point Likert scales were used to measure usefulness, ease of use, and confidence. Correct execution of exercises was evaluated using a simple rating scale (1-correctly demonstrated to 3-had difficulty and required assistance). The study was approved by the Medical Sciences Inter-divisional Research Ethics Committee (IDREC), University of Oxford. Results: A total of nine participants were included as one participant was unable to attend. Five participants (four females and one male; mean age 61 years) and four participants (four females; mean age 61.3 years) participated in the first and second cycles respectively. Usability issues identified with the think aloud protocol in Cycle 1 included the need for mySARAH navigation tutorial video, individualised feedback on pain levels, a task progression bar for each session which were rectified prior to Cycle 2. The need for more instructions for filling mySARAH forms was identified in Cycle 2 and rectified. Self-reports from both cycle participants indicated that users found the programme useful, easy to use and were confident in their ability to navigate the programme. All participants had good agreement (with scores above 6) on majority of the items of CSU. Eight participants correctly demonstrated all the exercises. One required some assistance. Conclusion: Our usability findings found mySARAH as an efficient and user-friendly programme. Usability testing is an important step in the design and development of user-centered web-based interventions before evaluating their effectiveness on a larger scale.