Usability Across Three mHealth Problem Solving Training Interventions for Diverse Neurodevelopmental and Neurological Populations: Multicase Usability Evaluation (Preprint)

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BACKGROUND Mobile health (mHealth) 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. OBJECTIVE This study aimed to characterize usability challenges and facilitators across three psychoeducational mHealth Problem Solving Training interventions and to identify technological, pedagogical, and sociocultural design features that can improve engagement, accessibility, and implementation for diverse users. METHODS A multi-method, multicase study was conducted with a total of n=14 participants who completed think-aloud usability sessions while interacting with one of three different mHealth PST interventions designed for persons with neurodevelopmental and/or neurological disability: (1) Epilepsy Journey 2.0, (2) Survivor’s Journey, and (3) Electronic Problem-Solving Training (ePST). Participants completed a presession technology comfort survey and the Comprehensive Assessment of Usability for Learning Technologies (CAUSLT) postsession. All sessions were recorded, transcribed, and analyzed thematically. CAUSLT data were analyzed using descriptive quantitative methods. RESULTS ePST demonstrated the highest usability (x̄ 88 out of 100, 95 percent CI 71.8 to 104.2), followed by Survivor’s Journey (x̄ 83 out of 100, 95 percent CI 57.1 to 108.9) and then Epilepsy Journey 2.0 (x̄ 79 out of 100, 95 percent CI 65.3 to 92.7). Findings revealed that usability in healthcare 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. CONCLUSIONS 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. 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.

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