{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,9,9]],"date-time":"2026-09-09T21:11:11Z","timestamp":1788988271640,"version":"build-2803163510"},"reference-count":59,"publisher":"JMIR Publications Inc.","content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["JMIR Hum Factors"],"abstract":"<jats:title>Abstract<\/jats:title>\n                  <jats:sec sec-type=\"background\">\n                    <jats:title>Background<\/jats:title>\n                    <jats:p>mHealth (mobile health) interventions that integrate psychoeducation with structured problem-solving training (PST) hold strong potential for improving self-management of chronic conditions. Evaluating the usability of these interventions requires assessing technological, pedagogical, and sociocultural fit. However, most usability evaluations remain narrowly technocentric, focusing on interface-level metrics while neglecting pedagogical coherence, cultural responsiveness, and patient learning needs.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec sec-type=\"objective\">\n                    <jats:title>Objective<\/jats:title>\n                    <jats:p>This exploratory study aimed to characterize usability challenges and facilitators across 3 psychoeducational mHealth PST interventions and to identify technological, pedagogical, and sociocultural design features that can improve engagement, accessibility, and implementation for diverse users.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec sec-type=\"methods\">\n                    <jats:title>Methods<\/jats:title>\n                    <jats:p>This study used an exploratory, multimethod, collective case study design. Three independent mHealth PST usability studies used structured think-aloud protocols, with sessions conducted remotely via Zoom (Zoom Communications, Inc), except for 1 in-person session for Epilepsy Journey 2.0. A total of 14 participants were enrolled across 3 independent cases via purposive sampling from their respective target populations. Case 1 \u2013 Epilepsy Journey 2.0 (n=6; 4 male, 2 female; ages 12\u201018 y; adolescents with epilepsy), case 2 \u2013 Survivor\u2019s Journey (n=3; 1 male, 2 female; ages 18\u201030 y; adolescent and young adult survivors of brain tumor), and case 3 \u2013 electronic problem-solving training (n=5; 2 male, 3 female; ages 30\u201065 y; adults with a history of severe traumatic brain injury). Participants completed a presession technology comfort survey and the Comprehensive Assessment of Usability for Learning Technologies postsession. All sessions were recorded, transcribed, and analyzed thematically. Comprehensive Assessment of Usability for Learning Technologies data were analyzed using descriptive quantitative methods.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec sec-type=\"results\">\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>Electronic problem-solving training demonstrated the highest usability (mean 87.96, SD 13.73), followed by Survivor\u2019s Journey (mean 83.00, SD 7.70), and then Epilepsy Journey 2.0 (mean 79.00, SD 12.75). Findings revealed that usability in health care learning design is shaped by how effectively the technology, learning content, and contextual factors align with patients\u2019 needs. Recurring challenges across interventions included unclear navigation, poor mobile responsiveness, instructional ambiguity, insufficient feedback, potential for greater inclusivity, and limited error recovery. Twelve cross-case design principles were derived, emphasizing mobile-first accessibility, cognitive load reduction, context-sensitive feedback, and empathetic, inclusive design.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec sec-type=\"conclusions\">\n                    <jats:title>Conclusions<\/jats:title>\n                    <jats:p>Usability challenges in mHealth PST interventions arise not only from interface-level issues but also from how effectively the intervention supports users\u2019 understanding, decision-making, and real-world application demands. This extends prior mHealth usability research by demonstrating that user difficulties often reflect misalignments between technological features, instructional structure, and the everyday contexts in which individuals engage with PST. The resulting design principles highlight specific, actionable priorities for developers, including mobile-first optimization, clearer task scaffolding, and better feedback and error recovery. Future work should evaluate these principles in larger samples and clinical settings to determine their impact on engagement, adherence, and downstream health outcomes.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.2196\/90379","type":"journal-article","created":{"date-parts":[[2026,7,22]],"date-time":"2026-07-22T15:05:06Z","timestamp":1784732706000},"page":"e90379-e90379","source":"Crossref","is-referenced-by-count":0,"title":["Usability Across 3 mHealth Problem-Solving Training Interventions for Diverse Neurodevelopmental and Neurological Populations: Multicase Usability Evaluation"],"prefix":"10.2196","volume":"13","author":[{"ORCID":"https:\/\/orcid.org\/0009-0008-4430-5582","authenticated-orcid":false,"given":"David","family":"Ogundairo","sequence":"first","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-4709-545X","authenticated-orcid":false,"given":"Shannon","family":"Juengst","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-7580-3751","authenticated-orcid":false,"given":"Avani","family":"Modi","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-3764-7126","authenticated-orcid":false,"given":"Shari","family":"Wade","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-8110-4367","authenticated-orcid":false,"given":"Matthew","family":"Schmidt","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1010","published-online":{"date-parts":[[2026,9,9]]},"reference":[{"issue":"5","key":"R1","doi-asserted-by":"publisher","first-page":"843","DOI":"10.1016\/j.amepre.2016.06.008","article-title":"Evaluating digital health interventions: key questions and approaches","volume":"51","author":"Murray","journal-title":"Am J Prev Med"},{"key":"R2","unstructured":"eHealth. World Health Organization - Regional Office for the Eastern Mediterranean. 2025. URL: http:\/\/www.emro.who.int\/health-topics\/ehealth\/ [Accessed 18-08-2026]"},{"issue":"1","key":"R3","doi-asserted-by":"publisher","DOI":"10.1186\/s12911-018-0591-0","article-title":"Effective behavioral intervention strategies using mobile health applications for chronic disease management: a systematic review","volume":"18","author":"Lee","journal-title":"BMC Med Inform Decis Mak"},{"key":"R4","unstructured":"Nezu AM D\u2019Zurilla TJ . Problem-Solving Therapy: A Positive Approach to Clinical Intervention. 3rd ed. Springer Publishing Company; 2006. URL: https:\/\/books.google.com\/books?hl=en&lr=&id=AovE6mAGFjEC&oi=fnd&pg=PR7&dq=Problem-Solving+Therapy:+A+Positive+Approach+to+Clinical+Intervention,+Third+Edition&ots=8r--8nQWhc&sig=waJ46a0ml5GK6D5_zf3R1QFK-w8 [Accessed 18-08-2026]"},{"issue":"12","key":"R5","doi-asserted-by":"publisher","first-page":"1407","DOI":"10.5498\/wjp.v11.i12.1407","article-title":"Psychoeducation in bipolar disorder: a systematic review","volume":"11","author":"Rabelo","journal-title":"World J Psychiatry"},{"issue":"6","key":"R6","doi-asserted-by":"publisher","first-page":"1213","DOI":"10.1097\/j.pain.0000000000000508","article-title":"Problem-solving skills training for parents of children with chronic pain: a pilot randomized controlled trial","volume":"157","author":"Palermo","journal-title":"PAIN"},{"issue":"8","key":"R7","doi-asserted-by":"publisher","DOI":"10.2196\/14284","article-title":"Long-term outcomes of a therapist-supported, smartphone-based intervention for elevated symptoms of depression and anxiety: quasiexperimental, pre-postintervention study","volume":"7","author":"Economides","journal-title":"JMIR mHealth uHealth"},{"issue":"5","key":"R8","doi-asserted-by":"publisher","DOI":"10.2196\/19262","article-title":"Effects of psychoeducational interventions using mobile apps and mobile-based online group discussions on anxiety and self-esteem in women with breast cancer: randomized controlled trial","volume":"9","author":"Ghanbari","journal-title":"JMIR mHealth uHealth"},{"key":"R9","doi-asserted-by":"publisher","DOI":"10.1016\/j.invent.2021.100448","article-title":"The effect of user interface on treatment engagement in a self-guided digital problem-solving intervention: a randomized controlled trial","volume":"26","author":"Hentati","journal-title":"Internet Interventions"},{"issue":"5","key":"R10","doi-asserted-by":"publisher","DOI":"10.2196\/35371","article-title":"Factors influencing adherence to mHealth apps for prevention or management of noncommunicable diseases: systematic review","volume":"24","author":"Jakob","journal-title":"J Med Internet Res"},{"key":"R11","doi-asserted-by":"publisher","DOI":"10.1016\/j.invent.2024.100735","article-title":"The conceptualisation and measurement of engagement in digital health","volume":"36","author":"Milne-Ives","journal-title":"Internet Interventions"},{"key":"R12","doi-asserted-by":"crossref","unstructured":"Hassan HM Galal-Edeen GH . From usability to user experience. Presented at: 2017 International Conference on Intelligent Informatics and Biomedical Sciences (ICIIBMS); Nov 24-26, 2017; Okinawa, Japan. [doi: 10.1109\/ICIIBMS.2017.8279761]","DOI":"10.1109\/ICIIBMS.2017.8279761"},{"key":"R13","unstructured":"ISO 9241. Ergonomics of human-system interaction \u2014 part 210: human-centred design for interactive systems. 2019. URL: https:\/\/www.iso.org\/obp\/ui\/#iso:std:iso:9241:-210:ed-2:v1:en [Accessed 18-08-2026]"},{"key":"R14","doi-asserted-by":"publisher","DOI":"10.1016\/j.jbi.2018.08.012","article-title":"A multi-level usability evaluation of mobile health applications: a case study","volume":"86","author":"Cho","journal-title":"J Biomed Inf"},{"issue":"1","key":"R15","doi-asserted-by":"publisher","first-page":"63","DOI":"10.1177\/2327857914031009","article-title":"Human factors and usability in mobile health design \u2013 factors for sustained patient engagement in diabetes care","volume":"3","author":"Goldwater","journal-title":"Proc Int Symp Hum Factors Ergon Health Care"},{"issue":"10","key":"R16","doi-asserted-by":"publisher","DOI":"10.2196\/17999","article-title":"Development of an intervention targeting multiple health behaviors among high school students: participatory design study using heuristic evaluation and usability testing","volume":"8","author":"M\u00fcssener","journal-title":"JMIR mHealth uHealth"},{"issue":"1","key":"R17","doi-asserted-by":"publisher","DOI":"10.1186\/s12911-020-01159-1","article-title":"Barriers to patient, provider, and caregiver adoption and use of electronic personal health records in chronic care: a systematic review","volume":"20","author":"Niazkhani","journal-title":"BMC Med Inf Decis Mak"},{"issue":"1","key":"R18","doi-asserted-by":"publisher","DOI":"10.1186\/s44247-024-00105-9","article-title":"Engagement and retention in digital mental health interventions: a narrative review","volume":"2","author":"Boucher","journal-title":"BMC Digit Health"},{"key":"R19","doi-asserted-by":"publisher","DOI":"10.2147\/CIA.S154717","article-title":"Usability and acceptability of technology for community-dwelling older adults with mild cognitive impairment and dementia: a systematic literature review","volume":"13","author":"Holthe","journal-title":"Clin Interv Aging"},{"key":"R20","doi-asserted-by":"publisher","DOI":"10.2196\/56556","article-title":"Usability and effectiveness of eHealth and mHealth interventions that support self-management and health care transition in adolescents and young adults with chronic disease: systematic review","volume":"26","author":"Li","journal-title":"J Med Internet Res"},{"key":"R21","unstructured":"Jahnke I Schmidt M Pham M Singh K . Sociotechnical-pedagogical usability for designing and evaluating learner experience in technology- enhanced environments. In: Learner and User Experience Research: An Introduction for the Field of Learning Design &Amp; Technology. 2020:127-145. URL: https:\/\/edtechbooks.s3.us-west-2.amazonaws.com\/pdfs\/36\/3246.pdf [Accessed 18-08-2026]"},{"issue":"6","key":"R22","doi-asserted-by":"publisher","first-page":"1951","DOI":"10.1007\/s11423-022-10152-6","article-title":"Usability research in educational technology: a state-of-the-art systematic review","volume":"70","author":"Lu","journal-title":"Educ Tech Res Dev"},{"key":"R23","unstructured":"John B . SUS: a \u201cquick and dirty\u201d usability scale. In: Usability Evaluation In Industry. CRC Press; 1996. URL: https:\/\/www.taylorfrancis.com\/chapters\/edit\/10.1201\/9781498710411-35\/sus-quick-dirty-usability-scale-john-brooke [Accessed 18-08-2026]"},{"issue":"6","key":"R24","doi-asserted-by":"publisher","first-page":"574","DOI":"10.1080\/10447310802205776","article-title":"An empirical evaluation of the system usability scale","volume":"24","author":"Bangor","journal-title":"Int J Hum\u2013Comput Interact"},{"issue":"1","key":"R25","doi-asserted-by":"publisher","first-page":"57","DOI":"10.1080\/10447319509526110","article-title":"IBM computer usability satisfaction questionnaires: psychometric evaluation and instructions for use","volume":"7","author":"Lewis","journal-title":"Int J Hum-Comput Interact"},{"key":"R26","unstructured":"Kirakowski J . The software usability measurement inventory: background and usage. In: Usability Evaluation In Industry. CRC Press; 1996. URL: https:\/\/www.taylorfrancis.com\/chapters\/edit\/10.1201\/9781498710411-33\/software-usability-measurement-inventory-background-usage-kirakowski [Accessed 18-08-2026]"},{"issue":"1","key":"R27","doi-asserted-by":"publisher","first-page":"75","DOI":"10.1080\/10447310802546716","article-title":"Developing a usability evaluation method for e-learning applications: beyond functional usability","volume":"25","author":"Zaharias","journal-title":"Int J Hum-Comput Interact"},{"issue":"1","key":"R28","doi-asserted-by":"publisher","first-page":"5","DOI":"10.1093\/jamia\/ocv099","article-title":"Quantifying usability: an evaluation of a diabetes mHealth system on effectiveness, efficiency, and satisfaction metrics with associated user characteristics","volume":"23","author":"Georgsson","journal-title":"J Am Med Inf Assoc"},{"issue":"1","key":"R29","doi-asserted-by":"publisher","DOI":"10.1186\/s13075-024-03291-z","article-title":"Usability and preliminary effectiveness of an app-based physical activity and education program for people with hip or knee osteoarthritis - a pilot randomized controlled trial","volume":"26","author":"Weber","journal-title":"Arthritis Res Ther"},{"issue":"9","key":"R30","doi-asserted-by":"publisher","DOI":"10.2196\/17983","article-title":"Effect of prior health knowledge on the usability of two home medical devices: usability study","volume":"8","author":"Chaniaud","journal-title":"JMIR mHealth uHealth"},{"issue":"1","key":"R31","doi-asserted-by":"publisher","DOI":"10.1038\/s41746-024-01162-0","article-title":"A scoping review assessing the usability of digital health technologies targeting people with multiple sclerosis","volume":"7","author":"Tea","journal-title":"NPJ Digit Med"},{"key":"R32","doi-asserted-by":"publisher","DOI":"10.2196\/57628","article-title":"Human factors, human-centered design, and usability of sensor-based digital health technologies: scoping review","volume":"26","author":"Tandon","journal-title":"J Med Internet Res"},{"key":"R33","doi-asserted-by":"publisher","DOI":"10.1016\/j.jss.2023.111881","article-title":"Potential effectiveness and efficiency issues in usability evaluation within digital health: a systematic literature review","volume":"208","author":"Maqbool","journal-title":"J Syst Software"},{"issue":"3","key":"R34","doi-asserted-by":"publisher","first-page":"413","DOI":"10.1136\/amiajnl-2010-000020","article-title":"Review of health information technology usability study methodologies","volume":"19","author":"Yen","journal-title":"J Am Med Inf Assoc"},{"issue":"2","key":"R35","doi-asserted-by":"publisher","DOI":"10.2196\/38259","article-title":"Usability methods and attributes reported in usability studies of mobile apps for health care education: scoping review","volume":"8","author":"Johnson","journal-title":"JMIR Med Educ"},{"key":"R36","doi-asserted-by":"publisher","DOI":"10.2196\/56897","article-title":"When and why adults abandon lifestyle behavior and mental health mobile apps: scoping review","volume":"26","author":"Kidman","journal-title":"J Med Internet Res"},{"issue":"2","key":"R37","doi-asserted-by":"publisher","DOI":"10.3390\/healthcare10020221","article-title":"User engagement and abandonment of mHealth: a cross-sectional survey","volume":"10","author":"Mustafa","journal-title":"Healthcare (Basel)"},{"issue":"4","key":"R38","doi-asserted-by":"publisher","DOI":"10.2196\/mhealth.4924","article-title":"Health app use among US mobile phone owners: a national survey","volume":"3","author":"Krebs","journal-title":"JMIR mHealth uHealth"},{"issue":"8","key":"R39","doi-asserted-by":"publisher","DOI":"10.2196\/12983","article-title":"The continued use of mobile health apps: insights from a longitudinal study","volume":"7","author":"Vaghefi","journal-title":"JMIR mHealth uHealth"},{"issue":"3","key":"R40","doi-asserted-by":"publisher","first-page":"1483","DOI":"10.1007\/s11423-024-10353-1","article-title":"Entangled eclecticism: a sociotechnical-pedagogical systems theory approach to learning experience design","volume":"72","author":"Schmidt","journal-title":"Educ Technol Res Dev"},{"key":"R41","unstructured":"Lu J Schmidt M Shin J . Beyond technological usability: exploratory factor analysis of the comprehensive assessment of usability scale for learning technologies (CAUSLT). arXiv. Preprint posted online on Feb 3, 2025. [doi: 10.48550\/arXiv.2501.18754]"},{"key":"R42","unstructured":"Creswell JW Poth CN . Qualitative Inquiry and Research Design: Choosing Among Five Approaches. 4th ed. SAGE Publications; 2018. URL: https:\/\/collegepublishing.sagepub.com\/products\/qualitative-inquiry-and-research-design-4-246896 [Accessed 18-08-2026]"},{"key":"R43","doi-asserted-by":"publisher","DOI":"10.1016\/j.yebeh.2017.04.009","article-title":"Development of a web-based executive functioning intervention for adolescents with epilepsy: the Epilepsy Journey","volume":"72","author":"Modi","journal-title":"Epilepsy Behav"},{"issue":"9","key":"R44","doi-asserted-by":"publisher","first-page":"1895","DOI":"10.1111\/epi.16317","article-title":"Epilepsy Journey: a proof of concept trial of a web-based executive functioning intervention for adolescents with epilepsy","volume":"60","author":"Modi","journal-title":"Epilepsia"},{"issue":"2","key":"R45","doi-asserted-by":"publisher","DOI":"10.1002\/pbc.28043","article-title":"A Survivor\u2019s Journey: preliminary efficacy of an online problem-solving therapy for survivors of pediatric brain tumor","volume":"67","author":"Wade","journal-title":"Pediatr Blood Cancer"},{"key":"R46","unstructured":"Juengst S Schmidt M . Smart technology, smarter design: person-centered adaptation of problem-solving training to ePST. Presented at: Rehabilitation Psychology Mid-Year Conference; Feb 20-23, 2025; Louisville, KY. URL: https:\/\/rehab.washington.edu\/news-and-events\/join-us-at-the-rehabilitation-psychology-mid-year-conference\/ [Accessed 29-08-2026]"},{"key":"R47","unstructured":"Weng Y Ogundairo D Martin K Schmidt M . A community-based participatory research to inform the design of electronic problem-solving training intervention for individuals with traumatic brain injury: a case study. Presented at: Mary Frances Early College of Education Research Conference; Apr 29, 2025; Athens, GA. URL: https:\/\/fyi.coe.uga.edu\/2025-04-register-for-the-2025-mary-frances-early-college-of-education-research-conference-on-april-29\/ [Accessed 29-08-2026]"},{"key":"R48","unstructured":"Patton MQ . Qualitative Research & Evaluation Methods: Integrating Theory and Practice. SAGE Publications; 2014. URL: https:\/\/study.sagepub.com\/patton4e [Accessed 18-08-2026]"},{"issue":"1","key":"R49","first-page":"34","volume":"5","author":"Macefield","journal-title":"J Usability Stud"},{"key":"R50","doi-asserted-by":"crossref","unstructured":"Nielsen J Landauer TK . A mathematical model of the finding of usability problems. Presented at: Proceedings of the INTERACT \u201993 and CHI \u201993 Conference on Human Factors in Computing Systems CHI \u201993; 1993:206-213; Amsterdam, The Netherlands. [doi: 10.1145\/169059.169166]","DOI":"10.1145\/169059.169166"},{"issue":"4","key":"R51","doi-asserted-by":"publisher","first-page":"457","DOI":"10.1177\/001872089203400407","article-title":"Refining the test phase of usability evaluation: how many subjects is enough?","volume":"34","author":"Virzi","journal-title":"Hum Factors"},{"issue":"3","key":"R52","doi-asserted-by":"publisher","first-page":"379","DOI":"10.3758\/bf03195514","article-title":"Beyond the five-user assumption: benefits of increased sample sizes in usability testing","volume":"35","author":"Faulkner","journal-title":"Behav Res Methods Instrum Comput"},{"key":"R53","unstructured":"Nielsen J . Severity ratings for usability problems. Nielsen Norman Group. Nov 1, 1994. URL: https:\/\/www.nngroup.com\/articles\/how-to-rate-the-severity-of-usability-problems\/ [Accessed 29-08-2026]"},{"issue":"7","key":"R54","doi-asserted-by":"publisher","DOI":"10.2196\/13817","article-title":"Patients\u2019 perceptions of mHealth apps: meta-ethnographic review of qualitative studies","volume":"7","author":"Vo","journal-title":"JMIR mHealth uHealth"},{"key":"R55","doi-asserted-by":"publisher","DOI":"10.2196\/45974","article-title":"Patients\u2019 experiences of a national patient portal and its usability: cross-sectional survey study","volume":"25","author":"Simola","journal-title":"J Med Internet Res"},{"key":"R56","doi-asserted-by":"publisher","DOI":"10.2196\/83995","article-title":"Designing electronic problem-solving training for individuals with traumatic brain injury: mixed methods, community-based, participatory research case study","volume":"28","author":"Schmidt","journal-title":"J Med Internet Res"},{"issue":"1","key":"R57","doi-asserted-by":"publisher","DOI":"10.1186\/s12911-024-02738-2","article-title":"Which criteria are important in usability evaluation of mHealth applications: an umbrella review","volume":"24","author":"Galavi","journal-title":"BMC Med Inf Decis Mak"},{"issue":"5","key":"R58","doi-asserted-by":"publisher","DOI":"10.2196\/36284","article-title":"Sociotechnical factors affecting patients\u2019 adoption of mobile health tools: systematic literature review and narrative synthesis","volume":"10","author":"Jacob","journal-title":"JMIR mHealth uHealth"},{"issue":"6","key":"R59","doi-asserted-by":"publisher","first-page":"2171","DOI":"10.1007\/s11423-022-10160-6","article-title":"Learning experience design of an mHealth self-management intervention for adolescents with type 1 diabetes","volume":"70","author":"Schmidt","journal-title":"Educ Technol Res Dev"}],"container-title":["JMIR Human Factors"],"original-title":[],"language":"en","deposited":{"date-parts":[[2026,9,9]],"date-time":"2026-09-09T20:51:22Z","timestamp":1788987082000},"score":1,"resource":{"primary":{"URL":"https:\/\/humanfactors.jmir.org\/2026\/1\/e90379"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2026,9,9]]},"references-count":59,"URL":"https:\/\/doi.org\/10.2196\/90379","relation":{},"ISSN":["2292-9495"],"issn-type":[{"value":"2292-9495","type":"electronic"}],"subject":[],"published":{"date-parts":[[2026,9,9]]},"article-number":"v13i5e90379"}}