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Table 5 Summary of problems cited by participants and subsequent changes implemented

From: The value of usability testing for Internet-based adolescent self-management interventions: “Managing Hemophilia Online”

  Problems cited Changes implemented
Iteration 1 English, n=4 A Venn diagram (Figure 2) comparing and contrasting the symptoms of arthritis and joint bleeds was not well understood by three users. The Venn diagram was re-tested in the second iteration to better identify the nature of users’ confusion.
Two users found the background colouring of the “History of Hemophilia” animation too dark and had difficulty understanding how to move through the animation. Users also suggested the animation be enlarged. The background colouring of the “History of Hemophilia” animation was lightened and instructions for use were included (Figure 6). The animation was also doubled in size.
Text explaining hemostasis, through an analogy to road repair, was found difficult to follow by users. The text was reproduced as a table (Figure 8).
Author credentials listed at the bottom of each web page were not understood by participants. Credentials were replaced with a brief lay sentence explaining each author’s professional role.
Two users sought a control to enlarge video size. The content management system did not support enlarged video.
All participants experienced difficulty navigating between modules and returning to the website’s home page. Text in the navigation menu was modified to change colour when clicked upon. A “home” button was added to the navigation menu.
Two users were unfamiliar with the mnemonic RICE, which was used as a caption for an image depicting bleed management. The mnemonic was re-tested in the second iteration to determine whether a higher proportion of users were unfamiliar with its meaning.
To emphasize the fragility of the synovial capsule, an analogy to a water balloon was made. Two users did not understand the analogy. A caption explaining the purpose of the analogy was included below a side-by-side image of a synovial capsule and water balloon.
  Problems cited Changes implemented
Iteration 2 English, n=4 An image illustrating the X-linked inheritance pattern of hemophilia (Figure 4) did not clearly discern why an affected father could not pass the trait onto his male offspring. Maternal and paternal chromosomes were differentially coloured to illustrate that offspring derive one sex chromosome from each parent (Figure 5).
The Venn diagram (Figure 2) continued to pose comprehension difficulties for users. The Venn diagram was broken down into multiple figures to first illustrate the symptoms of joint bleeds and arthritis as distinct sets, and then depict their joining (Figure 3).
Users continued to find the background colouring of the “History of Hemophilia” animation inadequate. The “History of Hemophilia” animation was re-tested in the third iteration to expand upon user suggestions for improvement.
Two additional users were unfamiliar with the mnemonic RICE. Users familiar with the mnemonic also expressed confusion as to the meaning of the letter “I” (I ce and/or I mmobilize). RICE was modified to RI2CE, to account for the dual-meaning of “I”. The meaning of each letter was described in individual paragraphs of text.
Iteration 3 English, n=4 Problems cited Changes implemented
Users continued to find the background colouring of the “History of Hemophilia” animation inadequate. Bright pictorial icons were added to improve the colour contrast of the animation (Figure 7).
Iteration 4 French, n=6 Problems cited Changes implemented
Three participants found the colouring of the videos too dark. Budget constraints prevented aesthetic modifications to the videos.
An English adage used on the site to help explain prophylactic factor use (Figure 8) did not bear the same meaning when translated into French. Despite this nuance, French adolescents understood the content conveyed by the analogy, making modification unnecessary.