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BMJ Open. 2019 May 27;9(5):e026748. doi: 10.1136/bmjopen-2018-026748.

User-testing an interactive option grid decision aid for prostate cancer screening: lessons to improve usability.

Author information

The Dartmouth Institute for Health Policy and Clinical Practice, Dartmouth College, Hanover, New Hampshire, USA.
Radboud University Medical Centre, Radboud University, Nijmegen, The Netherlands.
Department of Obstetrics and Gynaecology, Radboud University Nijmegen Medical Centre, Nijmegen, The Netherlands.



To user-test a web-based, interactive Option Grid decision aid 'prostate-specific antigen (PSA) test: yes or no?' to determine its usability, acceptability and feasibility with men of high and low health literacy.


A semi-structured interview study.


Interviews were conducted at a senior centre, academic hospital or college library in New Hampshire and Vermont.


Individuals over 45 years of age with no history of prostate cancer who voluntarily contacted study authors after viewing local invitations were eligible for inclusion. Twenty interviews were conducted: 10 participants had not completed a college degree, of which eight had low health literacy, and 10 participants had high health literacy.


An interactive, web-based Option Grid patient decision aid for considering whether or not to have a PSA test.


Users with lower health literacy levels were able to understand the content in the tool but were not able to navigate the Option Grid independent of assistance. The tool was used independently by men with high health literacy. In terms of acceptability, the flow of questions and answers embedded in the tool did not seem intuitive to some users who preferred seeing more risk information related to age and family history. Users envisioned that the tool could be feasibly implemented in clinical workflows.


Men in our sample with limited health literacy had difficulty navigating the Option Grid, thus suggesting that the tool was not appropriately designed to be usable by all audiences. The information provided in the tool is acceptable, but users preferred to view personalised risk information. Some participants could envision using this tool prior to an encounter in order to facilitate a better dialogue with their clinician.


The study received ethical approval from the Dartmouth College Committee for the Protection of Human Subjects (STUDY00030116).


health literacy; option grid patient decision aids; prostate-specific antigen test; think-aloud; user-testing; web-based, interactive decision aids

Conflict of interest statement

Competing interests: The Option Grid version that was shared in this work is no longer available. Interactive Option Grid patient decision aids are now available at and produced by EBSCO Health. Past: Glyn Elwyn has edited and published books that provide royalties on sales by the publishers: the books include Shared Decision Making (Oxford University Press) and Groups (Radcliffe Press). He has in the past provided consultancy for organizations, including: 1) Emmi Solutions LLC who developed patient decision support tools; 2) National Quality Forum on the certification of decision support tools; 3) Washington State Health Department on the certification of decision support tools; 4) SciMentum LLC, Amsterdam (workshops for shared decision making). Current: Founder and Director of &think LLC which owns the registered trademark for Option Grids TM patient decision aids. Founder and Director of SHARPNETWORK LLC, a provider of training for shared decision making. He provides consultancy in the domain of shared decision making and patient decision aids to: 1) Access Community Health Network, Chicago (Federally Qualified Medical Centers); 2) EBSCO Health Option Grids TM patient decision aids. Non-financial: Glyn Elwyn’s academic interests are focused on shared decision making and coproduction. He owns copyright in measures of shared decision making and care integration, namely collaboRATE, integRATE, Observer OPTION-5 and Observer OPTION-12. These measures are freely available for use by researchers. Dr Marie-Anne Durand is a consultant to Access Community Health Network. Together with Professor Elwyn, she has developed the Option GridTM patient decision aids, which are licensed to EBSCO Health. She receives consulting income from EBSCO Health and may receive royalties in the future.

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