Usability Across 3 mHealth Problem-Solving Training Interventions for Diverse Neurodevelopmental and Neurological...

mHealth (mobile health) interventions that integrate psychoeducation with structured problem-solving training (PST) hold strong potential for improving self-management of chronic conditions. Evaluating the usability of these interventions requires assessing technological, pedagogical, and sociocultural fit. However, most usability evaluations remain narrowly technocentric, focusing on interface-level metrics while neglecting pedagogical coherence, cultural responsiveness, and patient learning needs.

This exploratory study aimed to characterize usability challenges and facilitators across 3 psychoeducational mHealth PST interventions and to identify technological, pedagogical, and sociocultural design features that can improve engagement, accessibility, and implementation for diverse users.

This study used an exploratory, multimethod, collective case study design. Three independent mHealth PST usability studies used structured think-aloud protocols, with sessions conducted remotely via Zoom (Zoom Communications, Inc), except for 1 in-person session for Epilepsy Journey 2.0. A total of 14 participants were enrolled across 3 independent cases via purposive sampling from their respective target populations. Case 1 - Epilepsy Journey 2.0 (n=6; 4 male, 2 female; ages 12-18 y; adolescents with epilepsy), case 2 - Survivor's Journey (n=3; 1 male, 2 female; ages 18-30 y; adolescent and young adult survivors of brain tumor), and case 3 - electronic problem-solving training (n=5; 2 male, 3 female; ages 30-65 y; adults with a history of severe traumatic brain injury). Participants completed a presession technology comfort survey and the Comprehensive Assessment of Usability for Learning Technologies postsession. All sessions were recorded, transcribed, and analyzed thematically. Comprehensive Assessment of Usability for Learning Technologies data were analyzed using descriptive quantitative methods.

Electronic problem-solving training demonstrated the highest usability (mean 87.96, SD 13.73), followed by Survivor's Journey (mean 83.00, SD 7.70), and then Epilepsy Journey 2.0 (mean 79.00, SD 12.75). Findings revealed that usability in health care learning design is shaped by how effectively the technology, learning content, and contextual factors align with patients' needs. Recurring challenges across interventions included unclear navigation, poor mobile responsiveness, instructional ambiguity, insufficient feedback, potential for greater inclusivity, and limited error recovery. Twelve cross-case design principles were derived, emphasizing mobile-first accessibility, cognitive load reduction, context-sensitive feedback, and empathetic, inclusive design.

Usability challenges in mHealth PST interventions arise not only from interface-level issues but also from how effectively the intervention supports users' understanding, decision-making, and real-world application demands. This extends prior mHealth usability research by demonstrating that user difficulties often reflect misalignments between technological features, instructional structure, and the everyday contexts in which individuals engage with PST. The resulting design principles highlight specific, actionable priorities for developers, including mobile-first optimization, clearer task scaffolding, and better feedback and error recovery. Future work should evaluate these principles in larger samples and clinical settings to determine their impact on engagement, adherence, and downstream health outcomes.