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less-experienced patients to use a TT than it is for higher skilled and experienced participants.
Evaluating usability
In all earlier published articles on TTs [15-26] terms like ‘usability’, ‘ease of use’, ‘usefulness’, ‘acceptability’, ‘practicality’, ‘user-friendliness’ and ‘feasibility’ seem to be used as interchangeable terms and none of the authors have defined what they meant by these terms or how they measured them. All authors of those studies concluded that the TTs tested were easy to use for people with different levels of education, literacy or digital skills. These conclusions were based on study participants’ level of satisfaction with the ease of use of the tool [15,18,19,22], on results on efficiency of the tool [23], or both [15,17,21,24-26]. Effectiveness was not, or in case of Vargas [24] and Thumboo et al. [25] very minimally, tested. It is known that the TT of Hofmann et al. has been tested on satisfaction, efficiency and effectiveness, as was recommended by Frokjaer et al. [51], because these authors refer to these tests in their article published in 2010 [23]. However, the exact methods and results of those pre-tests were never published. According to Frokjaer et al., it is important to evaluate and report all three aspects of usability at the same time because they consider effectiveness, efficiency and satisfaction as independent aspects of usability and state that it is risky to assume that there are correlations between these aspects [51]. The results presented in Chapter 4.2 of this thesis confirm the necessity of combining all three aspects of usability, as all participants in the usability study of the Dutch TTSQ were extremely satisfied with the ease and efficiency with which they were able to use the TTSQ, while the results on effectiveness showed that it needed to be improved before it could be released. Based on the results of the study presented in Chapter 4.2, the authors purposed the Expectation Conformation Theory [52] as a possible explanation for the extremely high satisfaction among the participants. According to the Expectation Confirmation Theory [52], the more their expectations are exceeded the more satisfied people are. From the perspective of this theory, the low self-efficacy towards being able to use the TTSQ participants had in the study presented in Chapter 4.2 of this current thesis, in combination with the effort that was put into the design in order to make it easy to use, could have exceeded expectations among the participants. The results of a few earlier studies strengthens this hypothesis [17,19,21,26]. Yost et
General discussion
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