Improving Materials for a Technology-Based Childhood Obesity Intervention for Hispanic/Latino Families in Rural Nebraska: Mixed Methods Usability Test

Childhood obesity remains a public health concern in the United States, disproportionately affecting Hispanic/Latino and rural populations. Despite this disparity, there is a lack of culturally relevant programs specifically designed to reach this population. To address this gap, our team culturally adapted a technology-based childhood obesity intervention, Hispanic Family Connections (HFC), targeting Hispanic/Latino families living in rural areas. The intervention comprises 2 main components: interactive voice response (IVR) calls and a workbook with at-home activities to promote family engagement.

The objectives were to (1) evaluate the usability of the IVR calls and workbook included in the HFC intervention and (2) document and plan adaptations to these components using the FRAME (Framework for Reporting Adaptations and Modifications-Enhanced).

We conducted 5 mixed methods, task-based usability tests (UTs) using the think-aloud procedure. All 5 participants were women, self-identified as Hispanic/Latino, and were Spanish literate. Each participant completed 3 think-aloud tasks designed to evaluate the usability of the IVR calls and workbook chapters. Usability was assessed using the After-Scenario Questionnaire (ASQ) at the end of each task and the System Usability Scale (SUS) at the end of the UT session. All sessions were recorded, and data were organized into two primary categories: (1) quantitative results (ASQ and SUS) and (2) qualitative data (participants' comments and researchers' observations). Findings were compiled and analyzed following the 8 main domains of FRAME.

For the workbook, ASQ scores showed a high level of ease in task completion (mean 1.1, SD 0.32), satisfaction with completion time (mean 1.0, SD 0.00), and satisfaction with support information (mean 1.5, SD 0.97). For the IVR calls, participants reported a higher level of ease in task completion (mean 1.0, SD 0.00), satisfaction with completion time (mean 1.0, SD 0.00), and satisfaction with support information (mean 1.2, SD 0.45). SUS results were positive for 80% (4/5) of participants, with an average usability score above the benchmark (mean 75.5, SD 15.04). Using FRAME, we identified and documented 30 suggestions for adaptations and improvements to the workbook and IVR calls. The majority of suggestions were content-related (n=26, 86.67%), with most focusing on tailoring/tweaking, or refining existing materials.

The UT results, combined with systematic documentation using FRAME, allowed us to identify and prioritize the adaptations needed to improve the intervention materials. These refinements will prepare the HFC intervention for implementation in a subsequent feasibility study.