CC BY-NC-ND 4.0 · Yearb Med Inform 2022; 31(01): 074-081
DOI: 10.1055/s-0042-1742499
Special Section: Inclusive Digital Health
Working Group Contributions

Overcoming Challenges to Inclusive User-based Testing of Health Information Technology with Vulnerable Older Adults: Recommendations from a Human Factors Engineering Expert Inquiry

Linda W. Peute
1   Center for Human Factors Engineering of Health Information Technology, eHealth Living & Learning Lab Amsterdam, Amsterdam Public Health Research Institute, Amsterdam UMC, Location AMC, Department of Medical Informatics, Amsterdam, the Netherlands
Gaby-Anne Wildenbos
2   Center for Human Factors Engineering of Health Information Technology, Amsterdam Public Health Research Institute, Department of Medical informatics, Amsterdam UMC, Location AMC, Amsterdam, the Netherlands
Thomas Engelsma
1   Center for Human Factors Engineering of Health Information Technology, eHealth Living & Learning Lab Amsterdam, Amsterdam Public Health Research Institute, Amsterdam UMC, Location AMC, Department of Medical Informatics, Amsterdam, the Netherlands
Blake J. Lesselroth
3   School of Health Information Science, University of Victoria, Victoria, Canada
4   University of Oklahoma School of Community Medicine, Tulsa, Oklahoma, USA
Valentina Lichtner
5   Leeds University Business School, University of Leeds, Leeds, UK
Helen Monkman
3   School of Health Information Science, University of Victoria, Victoria, Canada
David Neal
6   Amsterdam UMC, location VUmc Department of Psychiatry, Amsterdam
Lex Van Velsen
7   Roessingh Research and Development, eHealth group, Enschede, The Netherlands
Monique W. Jaspers
1   Center for Human Factors Engineering of Health Information Technology, eHealth Living & Learning Lab Amsterdam, Amsterdam Public Health Research Institute, Amsterdam UMC, Location AMC, Department of Medical Informatics, Amsterdam, the Netherlands
Romaric Marcilly
8   Université de Lille, CHU Lille, ULR 2694 - METRICS: Évaluation des technologies de santé et des pratiques médicales, Lille, France. INSERM-CIC-IT 1403/Evalab, Lille, France
› Author Affiliations
Funding This research did not receive any specific grant from funding agencies in the public, commercial, or not-for-profit sectors.


Objectives: Involving representative users in usability testing of health information technology (HIT) is central to user-centered design. However, (vulnerable) older adults as representative users have unique requirements. Aging processes may affect physical capabilities and cognitive skills, which can hamper testing with this demographic and may require special attention and revised protocols. This study was performed to provide expert-based recommendations for HIT user-testing with (vulnerable) older adults to support inclusive HIT design and evaluation.

Methods: First, we conducted a structured workshop with ten experts in HIT implementation and research, recruited through purposeful sampling, to generate insights into how characteristics of older adults may influence user-testing. Next, five Human Factor researchers experienced in HIT user-testing with (vulnerable) older adults validated the results and provided additional textual insights to gain consensus on the most important recommendations. A thematic analysis was performed on the resulting inquiries. Applied codes were based on the User-Centered Design framework.

Results: The analysis resulted in nine recommendations for user-testing of HIT with older adults, divided into three main themes: (1) empathetic approach and trust-building, (2) new requirements for testing and study design, and (3) adjustments to usability evaluation methods. For each theme a checklist of relevant items to follow-up on the recommendation is provided.

Conclusions: The recommendations generated through expert inquiry contribute to more effective usability testing of HIT with older adults. This provides an important step towards improved accessibility of HIT amongst older adults through inclusive user-centered design.

Publication History

Article published online:
02 June 2022

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