Recommendations on Cognitive Debrief and Usability Studies for Instrument Migration from Paper to Electronic Modalities Based on Qualitative Synthesis of Validation Studies

01st, September 2023 | Downloads, eCOA

Exploring the Transition

Migrating Patient-Reported Outcomes from Paper to Electronic

The digitization wave presents the opportunity to migrate patient-reported outcome (PRO) instruments from paper to electronic platforms. This research delves into the intricacies of such a migration, especially focusing on minor instrument modifications and its implications.

KEY HIGHLIGHTS

Objective

Examine the ISPOR ePRO Taskforce’s 2009 recommendations on evidence needed for ensuring measurement equivalence during the transition from paper to electronic PRO instruments.

Analyze the results of cognitive debrief and usability studies linked to minor modifications in the instrument.

Methodology

A qualitative meta-summary of 53 cognitive debrief and usability studies conducted by ICON between 2012-2015 was undertaken.

The aim was to distill these findings into actionable recommendations for optimal practices and future validation requirements.

Results

Out of the 53 studies, 70 distinct PRO instruments were evaluated, culminating in a total of 102 instrument evaluations.

Instruments were primarily transitioned to tablets (51%), followed by handheld devices (47%) and PCs/laptops (2%).

An encouraging 82% of cognitive debriefs affirmed that the migration was suitable.

However, 5 studies (9%) surfaced minor findings which could potentially influence the instrument’s measurement capabilities. These concerns can be effectively tackled by adhering to established ePRO best practices, including:

  • Avoiding scrolling
  • Opting for legible font sizes
  • Ensuring Visual Analog Scale (VAS) line thickness is consistent
  • Offering clear instructions

Three studies were exclusive to usability as no paper version of the instrument was previously available. In the realm of usability, a whopping 92% of studies endorsed the current design, indicating no need for changes in elements like clarity, navigation, and operational ease.

A minority of studies flagged challenges with scrolling, navigation guidance, touchscreen responsiveness, and the touch area’s size. Addressing these issues calls for stringent adherence to design best practices, especially regarding the size, positioning, and responsiveness of navigation elements. It’s imperative to note that these issues are more reflective of the vendor’s design framework rather than the instrument migration itself.

In conclusion, migrating from paper to electronic PRO instruments is a feasible endeavor. The key to a seamless transition lies in embracing proven ePRO guidelines and ensuring vendor solutions are robust in design and user experience.

Willie Muehlhausen

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