Psychometric Validation of a User-Centered Usability and Acceptance Instrument for Home-Based Cognitive...

The aim of this study was to develop and validate a user-centered questionnaire to assess usability and acceptance of a tablet-based computerized cognitive rehabilitation program for older adults. A total of 35 preliminary items were generated based on the principles of Universal Design (UD) and user acceptance theories, including the Technology Acceptance Model, Information Systems Continuance Model, Net Promoter Score, and System Usability Scale. After expert review and item refinement, 25 items were finalized and administered to 101 older adults with cognitive impairment. Exploratory factor analysis revealed a three-factor structure-Physical & Cognitive Accessibility, Operational & Emotional Comfort, and Therapeutic Expectation & Behavioral Intention-explaining 87.3% of the total variance. Internal consistency reliability for each factor was high (Cronbach's α > 0.90). Correlation analysis showed that factor scores were significantly associated with age, gender, education level, and program usage variables (total time, average time, frequency), indicating that both demographic and behavioral factors influenced user responses. The strong inter-factor correlations also supported the structural coherence of the tool. These findings suggest that the developed instrument is a psychometrically sound and practically useful tool for assessing usability and user acceptance of digital rehabilitation technologies among cognitively impaired older adults. The tool may also inform user-centered design, clinical implementation strategies, and future research on digital therapeutics for aging populations. The validated item set demonstrates a distinctive strength in integrating accessibility-related usability grounded in UD principles with acceptance-related behavioral intentions, thereby differentiating this instrument from existing usability assessment tools for older adults.