Combining theory and usability testing to inform optimization and implementation of an online primary care depression management tool
Abstract Background The ‘Ottawa Depression Algorithm’ is an evidence-based online tool developed to support primary care professionals care for adults with depression. Uptake of such tools require provider behaviour change. Identifying issues which may impact use of an innovation in routine practice...
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| Format: | Article |
| Language: | English |
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BMC
2025-01-01
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| Series: | BMC Medical Informatics and Decision Making |
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| Online Access: | https://doi.org/10.1186/s12911-024-02733-7 |
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| author | Nicola McCleary Justin Presseau Isabelle Perkins Brittany Mutsaers Claire E. Kendall Janet Yamada Katharine Gillis Douglas Green |
| author_facet | Nicola McCleary Justin Presseau Isabelle Perkins Brittany Mutsaers Claire E. Kendall Janet Yamada Katharine Gillis Douglas Green |
| author_sort | Nicola McCleary |
| collection | DOAJ |
| description | Abstract Background The ‘Ottawa Depression Algorithm’ is an evidence-based online tool developed to support primary care professionals care for adults with depression. Uptake of such tools require provider behaviour change. Identifying issues which may impact use of an innovation in routine practice (i.e. barriers to and enablers of behaviour change) informs the selection of implementation strategies that can be deployed with the tool to support use. However, established theory-informed barriers/enablers assessment methods may be less well suited to identifying issues with tool usability. User testing methods can help to determine whether the tool itself is optimally designed. We aimed to integrate these two methodological approaches to i) identify issues impacting the usability of algorithm; and ii) identify barriers to and enablers of algorithm use in routine practice. Methods We conducted semi-structured interviews with primary care professionals in Ottawa, Canada. To evaluate usability, participants used a written patient scenario to work through the algorithm while verbalizing their thoughts (‘Think Aloud’). Participants were then asked about factors influencing algorithm use in routine practice (informed by the Theoretical Domains Framework). We used the codebook approach to thematic analysis to assign statements to pre-specified codes and develop themes pertaining to usability and routine use. Results We interviewed 20 professionals from seven practices. Usability issues were summarised within five themes: Optimizing content and flow to align with issues faced in practice, Enhancing the most useful algorithm components, Interactivity of the algorithm and embedded tools, Clarity of presence, purpose, or function of components, and Navigational challenges and functionality of links. Barriers to and enablers of routine use were summarised within five themes: Getting to know the algorithm, Alignment with roles and pathways of influence, Integration with current ways of working, Contexts for use, and Anticipated benefits and concerns about patient communication. Conclusions Whilst the Ottawa Depression Algorithm was viewed as a useful tool, specific usability issues and barriers to use were identified. Supplementing a theory-based barriers/enablers assessment with usability testing provided enhanced insights to inform optimization and implementation of this clinical tool. We have provided a methods guide for others who may wish to apply this approach. |
| format | Article |
| id | doaj-art-56751dc2b3af4256a62bb7498d600759 |
| institution | Kabale University |
| issn | 1472-6947 |
| language | English |
| publishDate | 2025-01-01 |
| publisher | BMC |
| record_format | Article |
| series | BMC Medical Informatics and Decision Making |
| spelling | doaj-art-56751dc2b3af4256a62bb7498d6007592025-01-19T12:26:03ZengBMCBMC Medical Informatics and Decision Making1472-69472025-01-0125112010.1186/s12911-024-02733-7Combining theory and usability testing to inform optimization and implementation of an online primary care depression management toolNicola McCleary0Justin Presseau1Isabelle Perkins2Brittany Mutsaers3Claire E. Kendall4Janet Yamada5Katharine Gillis6Douglas Green7Centre for Implementation Research, Clinical Epidemiology Program, Ottawa Hospital Research InstituteCentre for Implementation Research, Clinical Epidemiology Program, Ottawa Hospital Research InstituteCentre for Implementation Research, Clinical Epidemiology Program, Ottawa Hospital Research InstituteSchool of Psychology, University of OttawaC.T. Lamont Primary Health Care Research Centre, Bruyère Research InstituteDaphne Cockwell School of Nursing, Toronto Metropolitan UniversityDepartment of Psychiatry, University of OttawaDepartment of Psychiatry, University of OttawaAbstract Background The ‘Ottawa Depression Algorithm’ is an evidence-based online tool developed to support primary care professionals care for adults with depression. Uptake of such tools require provider behaviour change. Identifying issues which may impact use of an innovation in routine practice (i.e. barriers to and enablers of behaviour change) informs the selection of implementation strategies that can be deployed with the tool to support use. However, established theory-informed barriers/enablers assessment methods may be less well suited to identifying issues with tool usability. User testing methods can help to determine whether the tool itself is optimally designed. We aimed to integrate these two methodological approaches to i) identify issues impacting the usability of algorithm; and ii) identify barriers to and enablers of algorithm use in routine practice. Methods We conducted semi-structured interviews with primary care professionals in Ottawa, Canada. To evaluate usability, participants used a written patient scenario to work through the algorithm while verbalizing their thoughts (‘Think Aloud’). Participants were then asked about factors influencing algorithm use in routine practice (informed by the Theoretical Domains Framework). We used the codebook approach to thematic analysis to assign statements to pre-specified codes and develop themes pertaining to usability and routine use. Results We interviewed 20 professionals from seven practices. Usability issues were summarised within five themes: Optimizing content and flow to align with issues faced in practice, Enhancing the most useful algorithm components, Interactivity of the algorithm and embedded tools, Clarity of presence, purpose, or function of components, and Navigational challenges and functionality of links. Barriers to and enablers of routine use were summarised within five themes: Getting to know the algorithm, Alignment with roles and pathways of influence, Integration with current ways of working, Contexts for use, and Anticipated benefits and concerns about patient communication. Conclusions Whilst the Ottawa Depression Algorithm was viewed as a useful tool, specific usability issues and barriers to use were identified. Supplementing a theory-based barriers/enablers assessment with usability testing provided enhanced insights to inform optimization and implementation of this clinical tool. We have provided a methods guide for others who may wish to apply this approach.https://doi.org/10.1186/s12911-024-02733-7DepressionPrimary care professionalsBehaviour changeUsabilityQualitative methodsImplementation |
| spellingShingle | Nicola McCleary Justin Presseau Isabelle Perkins Brittany Mutsaers Claire E. Kendall Janet Yamada Katharine Gillis Douglas Green Combining theory and usability testing to inform optimization and implementation of an online primary care depression management tool BMC Medical Informatics and Decision Making Depression Primary care professionals Behaviour change Usability Qualitative methods Implementation |
| title | Combining theory and usability testing to inform optimization and implementation of an online primary care depression management tool |
| title_full | Combining theory and usability testing to inform optimization and implementation of an online primary care depression management tool |
| title_fullStr | Combining theory and usability testing to inform optimization and implementation of an online primary care depression management tool |
| title_full_unstemmed | Combining theory and usability testing to inform optimization and implementation of an online primary care depression management tool |
| title_short | Combining theory and usability testing to inform optimization and implementation of an online primary care depression management tool |
| title_sort | combining theory and usability testing to inform optimization and implementation of an online primary care depression management tool |
| topic | Depression Primary care professionals Behaviour change Usability Qualitative methods Implementation |
| url | https://doi.org/10.1186/s12911-024-02733-7 |
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