Meet Kica: Design, prototyping and user testing of a mobile application based on the WHO Caregiver Skills Training

Mobile-health approaches to caregiver-mediated interventions for autism hold great potential for implementation scale-up. However, essential phases of an application development cycle are often overlooked. This study reports on the development process of Kica, a novel mobile application based on the WHO Caregiver Skills Training (CST).

Contents and delivery methods for the initial prototype were designed with a user-centered approach, adapting CST contents and learning activities (Phase 1). In Phase 2, a comprehensive usability test of the prototype was then performed with 19 parents of 2-6-year-old autistic children. Participants rated the overall usability on the System Usability Scale (SUS) and received either the Cognitive Walkthrough (CW) task to assess app's ease of navigation or the Think-Aloud (TA) task for feedback on design, content, and usability. The prototype was then redesigned considering usability findings.

We report high usability on the SUS and high task success rates on the CW, except for three tasks more likely to be failed by participants with lower Italian proficiency. Thematic analysis of TA identified appreciation for the focus on caregiver/child interactions, ease of workflows navigation and enjoyability of visual branding. Suggestions included enhancing progress tracking and personalization and reducing text.

Usability testing highlighted strengths and areas for improvement that were incorporated into a revised prototype. Overall, the findings indicate good acceptability and support formal testing of feasibility and preliminary clinical efficacy through pilot testing.