Table 1.
Usability issues and corresponding modifications.
| Usability issues | Modifications to manual and resources |
|---|---|
| Cycle 1 | |
| • The main manual lacked details from and information about the safety protocol and the checklists | • More information about the safety routines was added, including how to handle common scenarios |
| • Adding a section on “online relationships” to the manual was valuable, but the users missed specific guidance and practical advice e.g. on how to facilitate discussions and how to use non-verbal communication online | • The section on online relationships was revised to include more clarifications and practical recommendations, including putting some of the recommendations as point-by-point advice |
| • There were uncertainties about how to identify which children are suitable to participate in online support groups and how to refer them onto other services if needed | • A section based on the family-centred approach, whereby participants are provided with information to empower them to make their own decision whether to participate or not, was added. This included a list of ‘pros’ and ‘cons’ of taking part and a pyramid image showing the different levels of care and where online-delivered TRT was located within the care structure |
| • The language was at times difficult to read and some terminology was confusing | • A language and readability check was performed. Words that had caused confusion were changed |
| • The layout was overall appealing but users were sometimes unsure about what the different boxes meant and in which order they should be read | • Instructions on how to use the manual were added. The use of boxes with practical tips were increased, since these were identified as helpful in the usability test |
| • The manual lacked instructions on how to work with interpreters online | • Guidance on working with interpreters online was added |
| • Holding individual meetings before the group sessions started was regarded as a good suggestion, but users were not sure when these meetings should be held | • The instructions on when to hold individual meetings were clarified |
| • Some facilitators might need more technical guidance on videoconferencing platforms/software | • Technical guidance was added on a separate page, so it could be easily skipped if not required. A section with guidance on how to choose a suitable platform and what to consider was included, based on existing guidelines for telehealth |
| • Sending a starting kit was expressed to be a good idea, but there were hesitations regarded some of the content, e.g. sending exercises and/or a diploma beforehand, as this would go against the idea of stepwise introduction of intervention content | • The content of the starting kit was revised and session-specific resources shared stepwise between sessions |
| • It was not clear to the users when to use the various online games suggested, and how to choose games for particular moments or groups | • A brief introduction was added, explaining when to use games and how to choose which games (e.g. depending on content of session and different groups). The layout was changed to “post-it notes”, with some left blank to enable facilitators to add their own game ideas |
| • The manual lacked recognition throughout that the content of the sessions needed to be adapted for different groups, depending on e.g. type of traumatic experiences and ages | • It was clarified throughout the manual that the content needs to be adapted to the group (age/type of experiences/cultural background), including which examples to use and which games to choose |
| Cycle 2 | |
| • It was not clear to users how and where to send the scoring of their wellbeing prior to each session | • Instructions were added to the manual on how to administer the wellbeing check. This involved the facilitator sending a message to the participants (by SMS, messaging app, or email), with a picture of the Cantril Ladder and a reminder of how to rate, sometime between 1 day to 1 h before. They were advised it can be helpful to agree upon a specific time with participants. The participants are asked to respond directly to the message with the number that corresponds to their rating |
| • Due to low volume and high speed, users sometimes found it challenging to follow the instructional audio and video recordings intended for use in between group sessions | • The video and audio files were re-recorded and/or edited, with improvements made in terms of volume and speed |
| • For the instructional videos intended for use in between group sessions, users called for clearer demonstrations of the techniques, e.g. breathing from the stomach | • The instructional videos were re-recorded with a young instructor. |
| • Clearer instructions and demonstrations of the techniques were added to the manual, along with a prompt to use the videos in between sessions | |
| • Users experienced technological disruptions, e.g. glitching in audio and video recordings and users not being able to see the full content of the screen when the facilitator used screen sharing | • Technical guidance for facilitators was added to the manual |
| • Interpreters were not able to log in, adjust camera and/or microphone and repeatedly asked for clarification of the techniques, which resulted in delays | • Guidance on working with interpreters online was added to the manual |
| • Users were disturbed by background noise | • It was clarified in letters to the participants' adult contact person, as well as to the participating children and young people, that participants should consider a place where they can sit without being disturbed before the session begins |