Testing the usability of a web-based hypospadias decision aid for parents using a user-centered design approach

Reconstructive surgery is advocated for most children with hypospadias to prevent potentially serious cosmetic and functional problems.

Parents faced with a decision about hypospadias repair encounter an irreversible choice with potentially lifelong consequences.

Recent studies have identified decisional conflict (DC) and decisional regret (DR) as a significant problem for parents.

Shared decision-making (SDM) addresses the issues of DC and DR by clarifying modifiable factors in decision-making and enabling families and physicians to utilize a bi-directional flow of information.

Decision aids (DA) facilitate SDM between families and physicians by providing decision support thereby improving decision quality.

Through my career development award (K23DK111987), I have completed a qualitative assessment to explore parents? informational needs for decision-making regarding hypospadias surgery.

This qualitative work has resulted in the creation of the ?Hypospadias Homepage,? a DA for use by parents/caregivers of children with hypospadias.

Our next step, as proposed in the K23 award, is to perform acceptability testing of the ?Hypospadias Homepage? outlined by the International Patient Decision Aids Standard Collaboration.

This will be done utilizing an ?acceptability questionnaire,? which will evaluate the amount, length, clarity, helpfulness and balanced manner of the information presented in the DA. However, the Hypospadias Homepage is not a traditional paper-based DA. Instead our DA is designed to be used by parents/caregivers via the Internet.

At the time of the initial K23 proposal we did not anticipate this mode of delivery, but the parents and providers proposed a DA that would be available online for convenience and ?24/7? availability.

When designing a DA for online delivery, it is necessary to assess the DA?s ?usability? (i.e., ease of learning, efficiency of use, memorability, error frequency and severity and subjective satisfaction). Therefore, we need to assess usability of the ?Hypospadias Homepage? in addition to conducting acceptability testing.

To accomplish this, I have partnered with experts in the evaluation of health information technology and human computer interaction.

By incorporating cutting-edge techniques for usability testing of the ?Hypospadias Homepage?, we will be able to identify a number of areas for improvement/revision.

We can then implement these changes prior to pilot field-testing of the DA in the clinical setting as proposed in Aim 4 of the K23 award.

The specific aim of this proposal is to conduct two rounds of usability testing in a naturalistic setting (i.e. an initial ?field test?) where parents/caregivers will be instructed to use the Hypospadias Homepage over a one-week period outside of the controlled research setting while we capture their interactions with the website using server-side data collection techniques.

Upon completion of the work proposed in this R03 application, as well as the work proposed in my K23 award, we will be well positioned to conduct a rigorous, large scale R01 study to test the efficacy of our hypospadias DA including its impact on patient-centered outcomes such as decisional conflict and decisional regret.