The usability, acceptability, and satisfaction of a digital mental health tool for patients with breast and prostate cancer

Abstract

The impact and use of digital health tools vary considerably among individuals dealing with somatic illnesses, such as cancer. This variability can be attributed to several factors, such as sociodemographic characteristics, baseline mental health, perception of the intervention’s usefulness, ease of use, and early engagement with the system. In this thesis, we aimed to examine the influence and interaction among these indicators on the usability, acceptability, satisfaction, and clinical effectiveness of a digital health tool in individuals with breast and prostate cancer.

All studies were based on data from the NEVERMIND trial, a clinical randomized controlled trial that included patients with five different somatic illnesses. Our study included 255 participants (at baseline) who were diagnosed with breast or prostate cancer. Half of the participants (n=129) were allocated to the NEVERMIND system, whereas the other half (n=125) were allocated to the treatment as usual (control) group. Those in the NEVERMIND system group were involved in the use of the NEVERMIND digital health tool, comprising a mobile app and sensorized shirt (shirt), over a 12-week period. Data from baseline assessments and follow-ups at four and 12 weeks were used. The aim was to assess the usability, acceptability, and satisfaction of the NEVERMIND system, as well as the factors associated with these dimensions. This Ph.D. project also examined how usability and acceptability impacted the clinical effectiveness of the NEVERMIND system on depressive and stress symptoms.

Study I. We investigated the association between baseline sociodemographic characteristics and usability assessed at four and 12 weeks of using the NEVERMIND system among 108 patients with breast and prostate cancer who received and used the system. The NEVERMIND system had good usability according to the usability questionnaires. Higher favourability of the mobile app was observed among women (breast cancer patients) compared to men (prostate cancer patients); however, men had significantly higher use of the overall system.

Study II. The relationships between sex, education, baseline depressive and stress symptoms, perceived ease of use, perceived usefulness, and system usage at various stages were examined using Bayesian Structural Equation Modelling in a path analysis of 129 patients with breast and prostate cancer. Higher perceived usefulness and initial usage were associated with a higher level of usage at 12 weeks. The results indicated that a better understanding of the system’s benefits and early engagement were key drivers of its sustained use and clinical effectiveness in improving mental health outcomes.

Study III. In a sample of 255 patients with breast and prostate cancer, we examined the relationship between the clinical effectiveness, usability, and acceptability of the NEVERMIND system when treating depressive and stress symptoms in patients with breast and prostate cancer. The results showed that patients in the NEVERMIND group had a greater reduction in depressive symptoms than those in the control group at the 12-week follow-up. The findings also showed that users who utilized the system for more than six weeks experienced a statistically significant decrease in both depressive symptoms and stress symptoms compared to those who used it for less than two weeks.

Study IV. This study looked at the overall satisfaction of users (68 with breast cancer and 39 with prostate cancer) with the NEVERMIND system. Satisfaction was measured at four and 12 weeks using a one-item questionnaire with two open-ended follow-up questions about user experiences. An inductive and deductive thematic analysis was conducted by using the NEVERMIND system’s components as a sensitizing concept which was then refined and interpreted through the lens of Information Systems (IS) success model. The findings show that 68.24% of users rated the system as good or excellent at four weeks, with a slight decrease to 65.42% at 12 weeks. Three themes emerged from the thematic analysis: (1) Fostering Personal Agency and Motivation, (2) Engagement and Interaction Experiences, and (3) Content Quality and Relevance. Gender differences emerged in the prioritization of emotional support among female users and self-awareness among male users. The satisfaction and challenges faced by users underscore the importance of a user-centric approach that focuses on holistic well-being, user engagement, personalized content, and technical stability. This study also contributes to the broader literature by utilizing IS success model as a framework for interpreting user satisfaction.

Conclusions. Higher levels of usability, acceptability, and satisfaction in the NEVERMIND system may contribute to improving the mental health outcomes of patients with breast and prostate cancer, both independently from each other, and even more so when high levels of engagement, acceptance, use, and satisfaction coexist. They emphasize the importance of perceived usefulness, initial engagement, and user-centric design in different components of the NEVERMIND system and confirms the multidimensionality of successful digital health tools implementation. Moreover, the notable differences in usability and preference between genders indicate that tailored and personalized strategies might serve as effective means to address diverse user needs. Taken together, these insights strengthen scientific evidence for healthcare experts and digital health innovators and developers, guiding them towards creating and designing digital health tools through user-centric and multi-domain approaches.