Iterative usability testing of a digital joint protection program for people with hand osteoarthritis

Hand osteoarthritis is a leading cause of pain, disability, and reduced quality of life in older adults. Joint protection programs are recommended as a core component of self-management, but traditional delivery is limited by barriers to access. Digital programs can overcome these challenges for some people, but their reach and effectiveness depend on usability. We conducted a mixed methods usability study of a remotely delivered joint protection program designed for people with hand osteoarthritis. Twenty-three participants took part, recruited through purposeful sampling to ensure inclusion of groups often underrepresented in research. Usability was assessed using predefined task completion, browser-based eye-tracking, participant ratings, and think-aloud protocols, with iterative refinements applied between participants. Routine navigation tasks, such as navigating between different modules, accessing interactive activities, and viewing short videos, were consistently completed with high success. More complex interactive tasks, including drag-and-drop activities, scenario-based modules, and toggling videos to full screen, initially posed challenges. Over successive iterations, however, usability improved markedly, with later participants achieving near-perfect performance. Qualitative analysis revealed that participants valued clear language, short and focused videos, interactive elements, and the ability to proceed at their own pace, while raising concerns about excessive clicking, unclear instructions, and variation in age representation. Iterative refinements, including platform adjustments, clearer instructions and an introductory video, addressed these issues and contributed to improved performance. This study demonstrates that a remotely delivered, technology-enabled joint protection program for hand osteoarthritis is usable, accessible, and engaging across a diverse sample. Beyond refining the program itself, the study introduces a practical framework for iterative, equity-informed usability testing that can inform the design of future digital health interventions.