Usability Testing of The International Cardiac Rehabilitation Registry

Abstract

Background: Cardiac rehabilitation (CR) is a comprehensive model of secondary preventive care for cardiovascular diseases (CVDs). However, there is a wide variety of implementation characteristics globally, specifically in low-and-middle-income countries. Thus, the International Council of Cardiovascular Prevention and Rehabilitation (ICCPR) was urged to develop a CR registry to establish the quality of CR services in such settings. Aim: To explore the usability of the newly developed International Cardiac Rehabilitation Registry (ICRR) in the World Health Organization's six-designated regions of the world to ensure the applicability and optimal utility of the registry before its launch. Methods: This was a mixed methods study comprised of Think-Aloud method to elicit feedback on the ICRR while end-users were entering patient data, followed by semi-structured interviews and SUS survey. The Unified Theory of Acceptance and Use of Technology 2 framework (UTAUT 2) informed the analysis. During the interview, participants were asked to log in to the ICRR demonstration site and share their screen and enter the patient's data anonymously while thinking and talking aloud. Notes including facial expressions and gestures ideas raised by the participants were taken. After that, a semi-structured interviews were conducted to explore the topic in depth.. Interviews were transcribed verbatim, thematic analysis was undertaken to categorize the content using NVIVO software. Finally, participants were asked to fill out the System Usability scale survey (SUS), which provides a global measure of system satisfaction. SUS score was calculated based on Brooke's standard scoring method. Results: Four major themes emerged from the interviews and Think-Aloud method: (1) ease of approvals, adoption, and implementation; (2) benefits for programs, (3) variables and their definitions, as well as (4) patient report & follow-up assessment. Based on participant feedback and utterances, suggestions for changes to the ICRR were implemented, including changes to the program survey, on-boarding processes, navigational instructions, inclusion of program logos, direction on handling unavailable data, and optimizing data completeness, as well as policies for program certification. System usability score (SUS) was (83.75) indicating that the registry was "excellent" and rated as class "A" technology. Conclusions: Results of this study proved that ICRR is relevant, user-friendly with high end-user satisfaction, and showed high perceived usefulness to support CR service quality. The usability of the ICRR was enhanced based on participants' feedback. The ICRR is ready for the next stage, which is the pilot testing before the final launch.