Abstract
Few studies have focused on procedural documents in the field of home medical devices, although incorrect use and usability problems can have important consequences for the patient's health. In this study, we focused on the procedural learning of a home medical device, a blood pressure monitor. Five formats (unimodal: text, audio, pictures; and multimodal: text/audio with pictures) were tested on 124 novice participants randomly assigned to 5 groups. We judged the quality of the formats on the basis of three metrics: efficiency (i.e., handling errors), effectiveness (i.e., consultation time of the procedure, execution time of the devices) and memorability (i.e., recall task). Results suggest that the audio format was more effective than the other groups but also the least efficient. We consider the audio format to be beneficial for patient safety because this format would oblige participants to use a strategy suited to the situation, namely an atomization of the action corresponding to a segmentation of information less likely to saturate working memory. Results in relation to the other formats did not show a more effective, efficient and memorable format. This lack of difference in user performance is nevertheless important, illustrating the need to adapt each instruction to the context of learning, i.e., according to the users, the environment, the resources and the complexity of the task to be executed.
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References
Agarwal R, Prasad J (1998) A conceptual and operational definition of personal innovativeness in the domain of information technology. Inf Syst Res. https://doi.org/10.1287/isre.9.2.204
Anderson JR (1982) Acquisition of cognitive skill. Psychol Rev 89(4):369–406. https://doi.org/10.1037/0033-295X.89.4.369
Baddeley A (1992) Working memory. Science 255(5044):556–559. https://doi.org/10.1126/science.1736359
Barello S, Triberti S, Graffigna G, Libreri C, Serino S, Hibbard J, Riva G (2016) eHealth for patient engagement: a systematic review. Front Psychol. https://doi.org/10.3389/fpsyg.2015.02013
Berney S, Bétrancourt M (2016) Does animation enhance learning? A meta-analysis. Comput Edu 101:150–167. https://doi.org/10.1016/j.compedu.2016.06.005
Bétrancourt M, Dillenbourg P, Montarnal C (2003) Computer technologies in powerful learning environments: the case of using animated and interactive graphics for teaching financial concepts. In: De Corte E, Verschaffel L, Entwistle N, Van merriënboer J (dir.) Powerful Learning Environments: Unravelling basic components and dimensions, Amsterdam, Elsevier. pp 143–157. https://citeseerx.ist.psu.edu/viewdoc/download?doi=10.1.1.86.5125%26rep=rep1%26type=pdf
Blankenship J, Dansereau DF (2000) The effect of animated node-link displays on information recall. J Exp Edu 68(4):293–308. https://doi.org/10.1080/00220970009600640
Boucheix J-M, Lowe RK, Bugaiska A (2015) Age differences in learning from instructional animations. Appl Cognit Psychol 29(4):524–535. https://doi.org/10.1002/acp.3131
Butcher KR (2006) Learning from text with diagrams: Promoting mental model development and inference generation. J Edu Psychol 98(1):182–197. https://doi.org/10.1037/0022-0663.98.1.182
Chandler P, Sweller J (1996) Cognitive load while learning to use a computer program. Appl Cognit Psychol 10(2):151–170. https://doi.org/10.1002/(SICI)1099-0720(199604)10:2%3c151::AID-ACP380%3e3.0.CO;2-U
Chaniaud N, Loup-Escande E, Metayer N, Megalakaki O (2019) Effets des manuels d’utilisation sur l’utilisabilité des dispositifs médicaux : Les cas d’un tensiomètre et d’un oxymètre de pouls. EPIQUE 2019:1–8
Cifter AS (2017) Blood pressure monitor usability problems detected through human factors evaluation. Ergonom Des 25(3):11–19. https://doi.org/10.1177/1064804617691397
Eiriksdottir E, Catrambone R (2011) Procedural instructions, principles, and examples: how to structure instructions for procedural tasks to enhance performance, learning, and transfer. Human Fact 53(6):749–770. https://doi.org/10.1177/0018720811419154
Elie C, Colombet I (2011) Méthodes d’estimation de la reproductibilité. Sang Thrombose Vaisseaux 23(3):138–145. https://doi.org/10.1684/stv.2011.0592
Fleury S, Jamet E (2015) Supervised automatic interpretation of technical documents: when interruption is a time saver. Perceptual Motor Skills 120(1):67–83. https://doi.org/10.2466/22.25.PMS.120v11x9
Fraser KL, Ayres P, Sweller J (2015) Cognitive load theory for the design of medical simulations. Simul Healthcare J Soc Simul Healthcare 10(5):295–307. https://doi.org/10.1097/SIH.0000000000000097
Fu W-T, Gray WD (2006) Suboptimal tradeoffs in information seeking. Cognit Psychol 52(3):195–242. https://doi.org/10.1016/j.cogpsych.2005.08.002
Ganier F (2004) Factors affecting the processing of procedural instructions: implications for document design. IEEE Trans Profess Commun 47(1):15–26. https://doi.org/10.1109/TPC.2004.824289
Ganier F, Gombert J-E, Fayol M (2000) Effets du format de presentation des instructions sur l’apprentissage de procedures a l’aide de documents techniques. Le Travail Humain 63(2):121–152
Ganier F (2002) Évaluer l’efficacité des documents techniques procéduraux : un panorama des méthodes. Le Travail Humain 65(1):1–27
Georgsson M, Staggers N (2016) Quantifying usability: an evaluation of a diabetes mHealth system on effectiveness, efficiency, and satisfaction metrics with associated user characteristics. J Am Med Inf Assoc 23(1):5–11. https://doi.org/10.1093/jamia/ocv099
Ginns P (2006) Integrating information: A meta-analysis of the spatial contiguity and temporal contiguity effects. Learn Instruct 16(6):511–525. https://doi.org/10.1016/j.learninstruc.2006.10.001
Guthrie JT, Bennett S, Weber S (1991) Processing procedural documents: a cognitive model for following written directions. Edu Psychol Rev 3(3):249–265. https://doi.org/10.1007/BF01320078
Heurley L (1994) Traitement de textes proceduraux : etude de psycholinguistique cognitive des processus de production et de comprehension chez des adultes non experts [Thesis, Dijon]. http://www.theses.fr/1994DIJOL001
Hornbaek K, Law EL-C (2007) Meta-analysis of correlations among usability measures. Proc SIGCHI Conf Human Factors Comput Syst. https://doi.org/10.1145/1240624.1240722
ISO 9241–11:2018 (s.d.) Ergonomics of human-system interaction -- Part 11: Usability: Definitions and concepts. ISO. Consulté 20 décembre 2018, à l’adresse http://www.iso.org/cms/render/live/en/sites/isoorg/contents/data/standard/06/35/63500.html
ISO/IEC 62366–1:2015. (s. d.) Medical devices -- Part 1: Application of usability engineering to medical devices. ISO. Consulté 20 décembre 2018, à l’adresse http://www.iso.org/cms/render/live/en/sites/isoorg/contents/data/standard/06/31/63179.html
Jamet E (2012) La compréhension des documents multimédias : de la cognition à la conception. Solal.
Jamet É, Arguel A (2008) La compréhension d’un document technique multimédia peut-elle être améliorée par une présentation séquentielle de son contenu ? Le Travail Humain 71(3):253–270
Jannin L, Ganier F, VriesDe P (2019) Atomized or delayed execution? An alternative paradigm for the study of procedural learning. J Edu Psychol. https://doi.org/10.1037/edu0000357
Jaspers MWM (2009) A comparison of usability methods for testing interactive health technologies: methodological aspects and empirical evidence. Int J Med Inf 78(5):340–353. https://doi.org/10.1016/j.ijmedinf.2008.10.002
Jeung H-J, Chandler P, Sweller J (1997) The role of visual indicators in dual sensory mode instruction. Edu Psychol 17(3):329–345. https://doi.org/10.1080/0144341970170307
Kalyuga S, Sweller J, Chandler P (2000) Incorporating learner experience into the design of multimedia instruction. Facul Edu Papers (Archive). https://doi.org/10.1037/0022-0663.92.1.126
Kools M, van de Wiel MWJ, Ruiter RAC, Kok G (2006) Pictures and text in instructions for medical devices: Effects on recall and actual performance. Patient Edu Counsel 64(1–3):104–111. https://doi.org/10.1016/j.pec.2005.12.003
Kortum P, Peres SC (2015) Evaluation of home health care devices: remote usability assessment. JMIR Human Factors 2(1):e10. https://doi.org/10.2196/humanfactors.4570
Kushniruk A (2002) Evaluation in the design of health information systems: application of approaches emerging from usability engineering. Comput Biol Med 32(3):141–149
Larsen T (2017) Nurses’ instruction of patients in the use of INR-monitors for self-management of cardio-vascular conditions: missed instructional opportunities. Patient Edu Counsel 100(4):673–681. https://doi.org/10.1016/j.pec.2016.10.001
Lemarié J, Castillan L, Eyrolle H (2017) Effects of expertise and multimedia presentation on the enactment and recall of procedural instructions. Psychol Française 62(4):351–359. https://doi.org/10.1016/j.psfr.2016.07.002
Mayer RE (2001) Multimedia Learning. Cambridge University Press, Cambridge
Mayer RE (2003) Elements of a science of e-learning. J Edu Comput Res 29(3):297–313. https://doi.org/10.2190/YJLG-09F9-XKAX-753D
Mayer RE, Moreno R (1998) A split-attention effect in multimedia learning: evidence for dual processing systems in working memory. J Edu Psychol 90(2):312–320. https://doi.org/10.1037/0022-0663.90.2.312
Morrell RW, Park DC, Poon LW (1990) Effects of labeling techniques on memory and comprehension of prescription information in young and old adults. J Gerontol 45(4):P166–P172. https://doi.org/10.1093/geronj/45.4.P166
Mousavi SY, Low R, Sweller J (1995) Reducing cognitive load by mixing auditory and visual presentation modes. J Edu Psychol 87(2):319–334. https://doi.org/10.1037/0022-0663.87.2.319
Mykityshyn AL, Fisk AD, Rogers WA (2002) Learning to use a home medical device: mediating age-related differences with training. Hum Factors 44(3):354–364. https://doi.org/10.1518/0018720024497727
Paas F, Van Gerven P, Tabbers H (2005) The cognitive aging principle in multimedia learning. In: Mayer R (ed) The Cambridge Handbook of multimedia learning. Cambridge University Press, Cambridge, pp 339–351
Paas F, Sweller J (2012) An evolutionary upgrade of cognitive load theory: using the human motor system and collaboration to support the learning of complex cognitive tasks. Edu Psychol Rev 24(1):27–45. https://doi.org/10.1007/s10648-011-9179-2
Rettig M (1991) Nobody reads documentation. Commun ACM 34(7):19–24. https://doi.org/10.1145/105783.105788
Rico-Olarte C, López DM, Kepplinger S (2018) Towards a conceptual framework for the objective evaluation of user experience. Marcus A, Wang W, (Éds) Design user experience, and usability: theory and practice. Springer, Berlin, pp 546–559
Savage PA, Kemp DG, Payne DE (1991) Auditory versus visual presentation of help messages. Proc Human Factors Soc Ann Meet 35(4):244–248. https://doi.org/10.1177/154193129103500408
Shrout PE, Fleiss JL (1979) Intraclass correlations: Uses in assessing rater reliability. Psychol Bull 86(2):420–428. https://doi.org/10.1037/0033-2909.86.2.420
Silver NC, Wogalter MS (1991) Strength and understanding of signal words by elementary and middle school students. Proc Human Factors Soc Ann Meet 35(9):590–594. https://doi.org/10.1518/107118191786754671
Sinatra GM, Heddy BC, Lombardi D (2015) The challenges of defining and measuring student engagement in science. Edu Psychol 50(1):1–13. https://doi.org/10.1080/00461520.2014.1002924
Sonderegger A, Schmutz S, Sauer J (2016) The influence of age in usability testing. Appl Ergon 52:291–300. https://doi.org/10.1016/j.apergo.2015.06.012
Stone DE, Glock MD (1981) How do young adults read directions with and without pictures? J Edu Psychol 73(3):419–426. https://doi.org/10.1037/0022-0663.73.3.419
Sweller J, Chandler P (1994) Why some material is difficult to learn. Cognit Instruct 12(3):185–233. https://doi.org/10.1207/s1532690xci1203_1
Szlichcinski KP (1979) Telling people how things work. Appl Ergon 10(1):2–8. https://doi.org/10.1016/0003-6870(79)90002-4
Tabbers HK, Martens RL, van Merriënboer JJG (2004) Multimedia instructions and cognitive load theory: effects of modality and cueing. Br J Edu Psychol 74(Pt 1):71–81. https://doi.org/10.1348/000709904322848824
Tissier I, Gronier G (2014) Impact of usability, user experience and motivation on the engagement to using a mobile application. In: Proceedings of the 26th conference on l’interaction homme-machine—IHM ’14, pp. 195–200. https://doi.org/https://doi.org/10.1145/2670444.2670470
van Hooijdonk C, Krahmer E (2008) Information modalities for procedural instructions: the influence of text, pictures, and film clips on learning and executing RSI exercises. IEEE Trans Professional Commun 51(1):50–62. https://doi.org/10.1109/TPC.2007.2000054
Vermersch P (1985) Données D’observation Sur L’utilisation D’une Consigne Ecrite: L’atomisation De L’action. Le Travail Humain 48(2):161–172
Wright P, Creighton P, Threlfall SM (1982) Some factors determining when instructions will be read. Ergonomics 25(3):225–237. https://doi.org/10.1080/00140138208924943
Wright P, Soroka AJ, Belt S, Pham DT, Dimov S, DeRoure DC, Petrie H (2008) Modality preference and performance when seniors consult online information. Gerontechnology. https://doi.org/10.4017/gt.2008.07.03.004.00
Wright P (1990) Integrating diagrams and text. Tech Writ Teacher 17(3):244–254
Acknowledgements
This project is financially supported by the European Regional Development Fund (ERDF), by Evolucare, and by the Programme d’Investissements d’Avenir (PIA), part of the PSPC 5 Projets de Recherche et Développement Structurants pour la Compétitivité. We would like also to thank Camille Richard for these precious illustrations.
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Authors declare that there is no conflict of interest. All procedures performed in studies involving human participants were in accordance with the ethical standards of the institutional and/or national research committee and with the 1964 Declaration of Helsinki and its later amendments or comparable ethical standards. This article does not contain any studies with animals performed by any of the authors. Informed consent was obtained from all individual participants included in the study.
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Handling Editor: Stefano Federici (University of Perugia).
Reviewers: Simone Borsci (Twente University), Maria Laura Mele (University of Perugia).
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Noémie, C., Natacha, M., Emilie, LE. et al. Impact of the format of user instructions on the handling of a wrist blood pressure monitor. Cogn Process 22, 261–275 (2021). https://doi.org/10.1007/s10339-020-01006-1
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DOI: https://doi.org/10.1007/s10339-020-01006-1