Development and usability testing of a web-based smoking cessation treatment for smokers with schizophrenia

• A web-based cessation treatment was developed for smokers with schizophrenia using a shallow hierarchy, large buttons, and explicit labels.
• Usability testing led to revisions including limiting each page to a single concept or function per page.
• Most participants using the website at home required additional support after a single training session.
• 80% of smokers with schizophrenia used the website as intended and were highly satisfied. One fifth (20%) quit smoking, 60% reduced smoking.

ABSTRACTIntroductionOver half of people with schizophrenia and other psychotic disorders smoke tobacco. Web-based approaches to cessation have been effective for the general population, but are not usable by many with schizophrenia disorders due to cognitive impairments and low computer experience. We developed a prototype smoking cessation treatment website for this group of smokers with features to reduce cognitive load. Here we report results from initial office-based usability testing and home-based field testing.MethodFive people were observed using the prototype website in the office with think-aloud cognitive interviewing. The website was modified based on these data. Six people then used the website on a home laptop after a single training session, with further coaching if needed.ResultsOffice-based testing showed that the website was usable, but required minor modifications. Further editing provided labels that were more explicit and concrete, limited the conceptual content on each page, and modified features of the support group forum. Home-based field-testing identified further functionality issues that were rapidly modified. Over half of users needed more than a single session of training to use the computer and website. Eighty three then used it independently and were very satisfied with the web-based program. Among the five smokers who field tested the prototype, 60% cut down and 20% had quit smoking after three weeks of home use.ConclusionThe prototype website was usable and satisfactory. With training and support, home use of this cessation website appears to be feasible and promising for cessation among smokers with schizophrenia. Further research is needed to evaluate web-based cessation treatment in people with psychotic disorders.