JMIR Publications

ABSTRACT

Background:

Federally Qualified Health Centers (FQHCs) are an essential place for underserved patients to access healthcare, including screening for colorectal cancer (CRC), one of the leading cause of cancer death in the U.S. Novel mechanisms aimed at increasing CRC screening completion rates at FQHCs (lower than national averages) are crucial.

Objective:

This study conducts interactive user-testing of a digital patient navigation tool, the eNav website, designed to support FQHC patients in preparing for, ordering, and completing CRC screening tests.

Methods:

We recruited English and Spanish speaking patients (N=20) at the Institute for Family Health into two iterative field tests (N=10 each). In each field test, participants engaged in a "think aloud" exercise and a qualitative interview to summarize and review their feedback. They also completed a baseline questionnaire gathering data about demographics, technology and internet use, medical history, and health literacy, and completed the System Usability Scale (SUS) and the Acceptability E-Scales. Based on participant feedback from the first field test, we modified the eNav website for the second round of testing.

Results:

Survey results supported the overall usability and acceptability of the website. The average SUS score for our first field test was 75.25; for the second, it was 75.28. The average Acceptability E-Scale score for our first field test was 28.3; for the second, it was 29.2. These scores are above recommended cutoffs for usability and acceptability. During "think aloud" exercises, in both field tests, many participants favorably perceived the website as motivating, interesting, informative and user-friendly. Respondents also gave suggestions on how to improve the website’s content, usability, accessibility, and appeal. Significantly, we found that some participants did not have the digital access or skills to interact with the eNav website at home.

Conclusions:

Based on participant feedback on the eNav website and reported limitations to digital readiness across both field tests, we made modifications to the content and design of the website. We also designed alternative methods of engagement with eNav to increase the tool’s usability, accessibility, and impact for patients with diverse needs. Next, we will test the eNav intervention in a randomized control trial to evaluate the efficacy of the eNav website for improving colorectal cancer screening uptake among patients treated at FQHCs.