DemSelf, a Mobile App for Self-Administered Touch-Based Cognitive Screening: Participatory Design With Stakeholders

TL;DR

DemSelf is a touch-based, self-administered cognitive screening app adapted from a paper test, with usability issues identified through expert feedback, highlighting the need for further validation and usability improvements.

Contribution

This study presents the participatory design process and usability evaluation of DemSelf, a novel mobile app for self-administered cognitive screening, adapting the Qmci instrument.

Findings

Usability issues found in all components of DemSelf.

Answer confirmation and correction mechanisms caused frustration.

Visual recognition differs from verbal recall, affecting test validity.

Abstract

Early detection of mild cognitive impairment and dementia is vital as many therapeutic interventions are particularly effective at an early stage. A self-administered touch-based cognitive screening instrument, called DemSelf, was developed by adapting an examiner-administered paper-based instrument, the Quick Mild Cognitive Impairment (Qmci) screen. We conducted five semi-structured expert interviews including a think-aloud phase to evaluate usability problems. The extent to which the characteristics of the original subtests change by the adaption, as well as the conditions and appropriate context for practical application, were also in question. The participants had expertise in the domain of usability and human-machine interaction and/or in the domain of dementia and neuropsychological assessment. Participants identified usability issues in all components of the DemSelf prototype. For example, confirmation of answers was not consistent across subtests. Answers were sometimes logged directly when a button is tapped and cannot be corrected. This can lead to frustration and bias in test results, especially for people with vision or motor impairments. The direct adoption of time limits from the original paper-based instrument or the simultaneous verbal and textual item presentation also caused usability problems. DemSelf is a different test than Qmci and needs to be re-validated. Visual recognition instead of a free verbal recall is one of the main differences. Reading skill level seems to be an important confounding variable. Participants would generally prefer if the test is conducted in a medical office rather than at a patient's home so that someone is present for support and the result can be discussed directly.