• Katherine L Dauber-Decker, Maria A Serafini, Rachel Monane, Lisa Grossman Liu, Alyssa Sales, Jennifer Mizhquiri Barbecho, Meredith E Diamond, Sera Levy, D 'Arcy King, Thomas McGinn, Suzanne Bakken, and Nathalie Moise.
• Northwell, New Hyde Park, NY, USA.
• J Gen Intern Med. 2024 Jun 5.

BackgroundFew patient engagement tools incorporate the complex patient experiences, contexts, and workflows that limit depression treatment implementation.ObjectiveDescribe a user-centered design (UCD) process for operationalizing a preference-driven patient activation tool.DesignInformed by UCD and behavior change/implementation science principles, we designed a preference-driven patient activation prototype for engaging patients in depression treatment. We conducted three usability cycles using different recruitment/implementation approaches: near live/live testing in primary care waiting rooms (V1-2) and lab-based think aloud testing (V3) oversampling older, low-literacy, and Spanish-speaking patients in the community and via EHR algorithms. We elicited clinician and "heuristic" expert input.Main MeasuresWe administered the system usability scale (SUS) all three cycles and pre-post V3, the patient activation measure, decisional conflict scale, and depression treatment barriers. We employed descriptive statistics and thematically analyzed observer notes and transcripts for usability constructs.ResultsOverall, 43 patients, 3 clinicians, and 5 heuristic (a usability engineering method for identifying usability problems) experts participated. Among patients, 41.9% were ≥ 65 years old, 79.1% female, 23.3% Black, 62.8% Hispanic, and 55.8% Spanish-speaking and 46.5% had ≤ high school education. We described V1-3 usability (67.2, 77.3, 81.8), treatment seeking (92.3%, 87.5%, 92.9%), likelihood/comfort discussing with clinician (76.9%, 87.5%, 100.0%), and pre vs. post decisional conflict (23.7 vs. 15.2), treatment awareness (71.4% vs. 92.9%), interest in antidepressants (7.1% vs. 14.3%), and patient activation (66.8 vs. 70.9), with fewer barriers pertaining to cost/insurance, access/coordination, and self-efficacy/stigma/treatment efficacy. Key themes included digital literacy, understandability, high acceptability for aesthetics, high usefulness of patient/clinician videos, and workflow limitations. We adapted manual entry/visibility/content; added patient activation and a personalized algorithm; and proposed flexible, care manager delivery leveraging clinic screening protocols.DiscussionWe provide an example of leveraging UCD to design/adapt a real-world, patient experience and workflow-aligned patient activation tool in diverse populations.© 2024. The Author(s), under exclusive licence to Society of General Internal Medicine.

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