Developing a quit smoking website that is usable by people with severe mental illnesses.

Ferron JC, Brunette MF, McHugo GJ, Devitt TS, Martin WM, Drake RE.  Dartmouth Psychiatric Research Center, Lebanon, NH 03766, USA.  Psychiatr Rehabil J. 2011 Fall;35(2):111-6. doi: 10.2975/35.2.2011.111.116.

OBJECTIVE: Evidence-based treatments may be delivered in computerized, web-based formats. This strategy can deliver the intervention consistently with minimal treatment provider time and cost. However, standard web sites may not be usable by people with severe mental illnesses who may experience cognitive deficits and low computer experience. This manuscript reports on the iterative development and usability testing of a website designed to educate and motivate adults with severe mental illnesses to engage in smoking cessation activities.

METHODS: Three phases of semi-structured interviews were performed with participants after they used the program and combined with information from screen-recorded usability data. T-tests compared the differences between uses of the first computer program version and a later version.

RESULTS: Iteratively conducted usability tests demonstrated an increased ease of use from the first to the last version of the website through significant improvement in the percentage of unproductive clicking along with fewer questions asked about how to use the program. The improvement in use of the website resulted from changes such as: integrating a mouse tutorial, increasing font sizes, and increasing button sizes.

CONCLUSIONS AND IMPLICATIONS FOR PRACTICE: The website usability recommendations provide some guidelines for interventionists developing web tools for people who experience serious psychiatric disabilities. In general, insights from the study highlight the need for thoughtful design and usability testing when creating a website for people with severe mental illness.