Development and usability testing of a web-based physical activity guidance tool for men with metastatic prostate cancer

Phase 1– The intervention will be developed in collaboration with the exercise medicine research group at Edith Cowan University, who specialize in exercise prescription for men with prostate cancer. The group have already developed an effective face-to-face program for men with bone metastases (Galvão et al., 2011), which we will adapt for use in an online setting. To ensure the end product is person-centred, we will conduct qualitative research as part of the intervention design process (n = ~10). This is considered best practice for designing digital health interventions that meet user needs (Yardley et al, 2016). Once we have a working prototype, we will then conduct usability and safety tests within a controlled setting. A small sample of men with metastatic prostate cancer(n = ~10)will be invited to utilize the intervention in a lab-based setting. This will involve navigating around the website, generating and viewing their tailored exercise prescription and then undertaking the recommended exercises (without and then with the use of a mirror). Stage 1. Baseline data collection (15 minutes) Participants are asked to complete a questionnaire assessing demographics, health-related information, current exercise levels, exercise goals, and self-rated exercise knowledge and confidence and outcome expectations. Stage 2. Usability testing - think-aloud test. (30 minutes) Participants are asked to perform key tasks on the website and prompted to think aloud while doing so. The tasks include completing the exercise prescription module to generate their tailored exercise recommendation. Stage 3. Free-time to privately use the website (5-10 minutes) Stage 4. Direct observation. (30-45minutes) Participants complete a face-to-face assessment to determine their suitability for performing the exercises recommended by the website. Participants are asked to perform all safe exercises whilst being recorded with and without a mirror. The use of the mirror (or not) will be randomized to reduce the impact of practice effects. For each exercise, the participant will watch the video as many times as necessary, complete their own set-up and when they believe they are ready to complete the exercise, they will let the researcher know. They will complete 6-8 repetitions per exercise. Exercises prescribed will be based on metastases location, pain levels, previous experience, fatigue levels and confidence in exercise. Exercise include but are not limited to seated exercise band press, standing exercise row, seated march, supine single leg extension (in hook lie), quarter squat, exercise band knee extension and standing calf raise. To ensure participant safety while performing the exercises, a qualified exercise professional will be available onsite and will observe the session. They will be instructed to ensure the participant does not complete any exercises that would put them at risk and to offer assistance if the individual requires it. If any assistance or corrections are provided, this will be documented and reported as part of the evaluation of the website. Stage 5. Follow-up assessment. (20 minutes) Participants are asked to complete a brief questionnaire re-assessing baseline questions about exercise knowledge, confidence and outcome expectations, as well as the system usability scale and acceptability items relating to relevance, usefulness and credibility. Participants are also asked to participate in a brief interview regarding what they liked and did not like about the website. In total, the duration of the intervention will be 2 hours, however, the participant is welcome to cease testing at any time. This process will be filmed with the participants permission. An Independent review board of experienced exercise physiologists will review the footage to objectively assess the quality of the prescription provided by the website and the participant’s exercise technique using an evidence-based pro forma. The panel will be asked to rate the quality of the technique, in terms of safety and efficacy on a scale of 0 (unsatisfactory) to 3(good) using an evidence-based proforma. The average rating for each exercise reviewed, as well as inter-rater reliability of reviewers will be reported. Where possible, identified issues will be addressed before the next participant utilizes the website. Testing will continue until no major issues are identified. This method of evaluation will ensure participant safety, whilst also allowing us to test proof of concept and iron out any system errors or safety concerns before progressing to phase 2.