Qualitative study measuring the usability of the International Cardiac Rehabilitation Registry

OBJECTIVE: Cardiac rehabilitation (CR) is a comprehensive model of secondary preventive care. There is a wide variety in implementation characteristics globally, and hence quality control is paramount. Thus, the International Council of Cardiovascular Prevention and Rehabilitation was urged to develop a CR registry. The purpose of this study was to test the perceived usability of the International Cardiac Rehabilitation Registry (ICRR) to optimise it. DESIGN: This was a qualitative study, comprising virtual usability tests using a think-aloud method to elicit feedback on the ICRR, while end-users were entering patient data, followed by semistructured interviews. SETTING: Ultimately, 12 tests were conducted with CR staff (67% female) in low-resource settings from a variety of disciplines in all regions of the world but Europe before saturation was achieved. PRIMARY OUTCOME MEASURE: Participants completed the System Usability Scale. Interviews were transcribed verbatim except to preserve anonymity, and coded using NVIVO by two researchers independently. The Unified Theory of Acceptance and Use of Technology 2 informed analysis. RESULTS: The ICRR was established as easy to use, relevant, efficient, with easy learnability, operability, perceived usefulness, positive perceptions of output quality and high end-user satisfaction. System usability was 83.75, or ‘excellent’ and rated ‘A’. Four major themes were deduced from the interviews: (1) ease of approvals, adoption and implementation; (2) benefits for programmes, (3) variables and their definitions, as well as (4) patient report and follow-up assessment. Based on participant observation and utterances, suggestions for changes to the ICRR were implemented, including to the programme survey, on-boarding processes, navigational instructions, inclusion of programme logos, direction on handling unavailable data and optimising data completeness, as well as policies for authorship and programme certification. CONCLUSIONS: With usability of the ICRR optimised, pilot testing shall ensue.