Qualitative Study on the Perceived Ease of Use of a Knowledge Translation Website: www.strokengine.ca

Special Article – Stroke Rehabilitation

Phys Med Rehabil Int. 2020; 7(1): 1168.

Qualitative Study on the Perceived Ease of Use of a Knowledge Translation Website: www.strokengine.ca

Yasmine Chibane1,2 and Annie Rochette1,2*

¹School of Rehabilitation, University of Montreal, Montreal, Canada

²Centre for Interdisciplinary Research in Rehabilitation in greater Montreal (CRIR), Montreal, Canada

*Corresponding author: Annie Rochette, OT, PhD, School of Rehabilitation, Université de Montréal, C.P. 6128, Succursale Centre-Ville, Pavillon Parc, Montréal (Québec) H3C 3J7, Canada

Received: January 13, 2020; Accepted: March 06, 2020; Published: March 13, 2020


Objective: To assess the perceived ease of use of Strokengine, a knowledge translation website on stroke rehabilitation by targeted users.

Methods: A qualitative approach gathering each participant’s opinion on the strengths and weaknesses while performing specific tasks (n=10), based on a standardised scenario. Ease of use was further informed by the Post Study System Usability Questionnaire. The data was analysed according to a theoretical thematic analysis.

Results: The eight participants (two clinicians, two students, two stroke survivors and two family members) were between 21 and 83 years of age. All but one relative indicated good satisfaction with the site, as the role of the relative was perceived as not being sufficiently highlighted. According to participants (7/8), the site is useful, fast, easy to learn and has a good quality interface and information. The organization of the interventions section (3/8 participants) makes it difficult to find information. For a family member and one student, the site should have fewer contrasts of colour and condensed text.

Conclusion: Overall, Strokengine is easy to use as it is practical for searching evidence-based information, fast and easy to learn.

Practice Implications: Results highlights the importance of periodically assessing ease of use of knowledge translation websites.

Keywords: Knowledge translation; Stroke; Usability; Website; Rehabilitation


Knowledge transfer (KT) in health is a structured process of making the results of scientific research accessible to professional practice, policy development and the general public [1]. This is done to promote appropriate use of knowledge by potential users [2]. To be effective, KT involves the popularization of knowledge in accessible language and tools that can be used in real situations (e.g. website).

Websites with health as their main subject have been around since the 1990s and have become an important source of information for Internet users. While so-called scientific information was produced, disseminated and controlled by scientists and/or the state, now anyone with access to the Internet can produce this type of information [3]. Content may therefore be false and different issues must be considered (e.g. health, safety or well-being). To address this, evidence-based sites have emerged so that factual information (from research) is shared with potential users and follows current clinical practices [4].

The www.strokengine.ca site (called Info-AVC in French) is an example. Its mission is to make research data on stroke rehabilitation accessible to bridge the gap with current practices. It is intended for anyone who wants evidence-based information on stroke rehabilitation, specifically clinicians, stroke survivors and their families. Strokengine offers information from quality articles, websites and systematic reviews on the various assessment tools useful in stroke rehabilitation. This site also presents the level of evidence of the effectiveness of stroke rehabilitation interventions following a thorough review by the site team. More recently, it includes also e-learning resources such as e-aerobics online course for physiotherapists.

An essential quality measure when designing a website is its ease of use. This concept refers to the degree to which a product can be used by users to perform specific tasks effectively, efficiently and satisfactorily in a specific context [5]. ISO-9241 norm thus introduces three concepts when defining ease of use: effectiveness, efficiency and satisfaction [5]. Effectiveness refers to the ability of users to achieve given goals in specific environments (accurately and completely). Efficiency involves the resources/efforts deployed to achieve the goal. Rather, satisfaction is about the comfort and acceptability of the system to its users. Several other qualities have an impact on the usability of a website, including usefulness in relation to the task, accessibility to users, ease of learning and user safety [6]. A site with low usability would, for example be an easy to use site, but one that does not allow the user to perform a task adequately. As a result, a website with good usability is useful for the task at hand, accessible to users, secure, efficient (fast) and easy to learn. Since the application of the various principles in the literature related to ease of use does not guarantee a perfect site, the evaluation phase is essential [7].

In the scientific literature, two studies have been previously conducted in relation to the Strokengine site and its ease of use [8,9]. However, these are usability assessments of older versions/platforms of the site (2009 and 2012). Indeed, the Strokengine-Family site, the Strokengine for clinicians and the Strokengine-Assessment are now integrated into a single website that has another configuration. For this website, specifically, a usability assessment has not been conducted while users are currently looking for information on this site to guide them in their decision-making. Thus, the objective of this study was to assess and describe the perceived ease of use of Strokengine by website users in order to improve the website.


A qualitative approach [10,11] was adopted for the following study, which was approved by the Research Ethics Board of Institutions where recruitment took place.

The target sample was eight people: two clinicians, two students, two people who had had a stroke and two relatives of people who had had a stroke. This sample represents the users who are most likely to access the Strokengine site. Some authors indicate that at five users, 80% of website problems are detected [12,13]. Others, such as Turner and colleagues [14], indicate that a group of seven participants is optimal. Indeed, the majority of problems should be detected by first users and the chances of further problems being discovered decrease with additional users [14]. As a result, with eight participants, it was expected that the majority of the site’s problems would be detected.

Clinicians practicing with a stroke clientele, on a part-time or full-time basis in an affiliated rehabilitation center were recruited by e-mail, as were students in the professional master’s degree in occupational therapy from an affiliated University in Quebec, Canada. People who had a stroke in the last five years (era of medical technology) and relatives of patients with stroke were recruited either from the Department of Physical Medicine and Rheumatology located in Belgium or from the Canadian Heart and Stroke Foundation. Participants had to be able to understand and speak French. Persons with significant cognitive or phasic impairments based on clinical judgment preventing informed consent were excluded.

In this study, the informal approach to ease-of-use testing was prioritized. Thus, instead of an expert evaluating the site, participants had to use the site by performing specific tasks presented in the form of instructions [15]. Throughout the process, the evaluator asked the participant to talk out loud. This approach made it possible to highlight serious and recurring problems when using the site while measuring the impact of problems on users and thus establishing a priority for problem resolution. For example, by giving a specific task to the user to find a specific assessment on the site made it possible to determine if the user can find the assessment without difficulty. If there were any difficulties, they were noted and then analyzed. Realtime observation determined whether this was due to factors specific to the individual (e.g., lack of experience with Internet use) or rather external factors such as the readability of the characters on the site or the visual organization of the site.

Data collection was based on the methodological approaches for the evaluation of health information systems [16]. The aim was to observe users’ interactions with the site, observe their performance and record their preferences through a scenario lasting a maximum of thirty minutes. The scenario comprised ten varied tasks such as accessing the strokengine website in French, finding all assessments relating to driving post-stroke, finding a list of all interventions or finding a way to contact the team. To observe users’ interactions with the site, data collection grids were used to record important information (e.g. general comments, errors made, slowdowns, user irritations or expressed wishes). Participants were filmed during the process for any additional information during the analysis of the results. Following the completion of the scenario, the evaluator completed with the user a free translation of the Post Study System Usability Questionnaire (PSSUQ) [17] to assess the participant’s satisfaction with the use of the website. The questionnaire was used in an exploratory and complementary manner to qualitative data collection. These are 19 questions with answers on a Likert-type scale (7 points) where the lower the answer, the higher the participant’s satisfaction with the site. Following each question, there is a space provided for comments to clarify/expand the participant’s answers. The PSSUQ can be used to produce a mean measurement of the user’s overall satisfaction with the site (questions 1-19) as well as measures of three sub-scales: system utility (questions 1-8), information quality (questions 9-15) and interface quality (questions 16-18). It thus makes it possible to evaluate the participant’s experience when using the website. This questionnaire has excellent reliability at the level of the three subscales (0.91 to 0.96). As for validity, the user’s overall satisfaction with the site, as well as the usefulness of the system and the quality of the interface, are significantly correlated with the success rate of the scenarios. This questionnaire is also sensitive to differences between subscales [18].

Each participant was met once for a maximum of one hour. The profile of each user was detailed, by interview, which included sociodemographic data (gender, age, category of participant) as well as data to describe their knowledge and experience with a computer. Indeed, user’s knowledge is essential in order to make assumptions about performance and difficulties encountered. Each participant had to perform the tasks detailed in the scenario. The participant was informed of the tasks to be performed and had to estimate the time required to complete all tasks to the nearest minute. The scenario was designed to assess the efficiency, effectiveness and satisfaction of participants with the use of the site. The scenario consisted of tasks that users are likely to perform [15]. All users had to perform the same scenario. Indeed, according to the informal approach of the usability tests [15], the same scenarios are presented to all participants to identify the main issues of the site despite the characteristics of the people. Following the completion of the scenario, the evaluator completed, with the user, the Post Study System Usability Questionnaire (PSSUQ) (the free translation of the questionnaire) in the form of an interview.

The purpose of the data analysis was to identify and document the problems and aspects appreciated when using the site and then prioritize problem solving. The data analysis was carried out in three steps:

User Profile: The data collected in relation to the user profile was tabulated to interpret the results and enrich the discussion.

Scenario analysis: A theoretical thematic analysis was conducted using Braun & Clarke [19] approach for the eight sessions (content of video recordings, observation grids and user comments/suggestions) by categorizing the data according to the main themes presented in the PSSUQ using a hypothetical-deductive process [19]. This was done in order to highlight the problems and positive aspects and thus to highlight the trends and singularities related to ease of use specifically.

Analysis of the questionnaires: The responses to the PSSUQ questions were further developed through participant feedback and allowed for a better understanding of the problems and positive aspects identified by users. This data was included in the theoretical thematic analysis.


Two clinicians (Neuropsychologist and Physiotherapist), two students (Student1 and Student2), two stroke survivors (Stroke1 and Stroke2) and two relatives (Niece and Sister), aged 21 to 83, participated in the study (Table 1). All participants had been using a computer for more than 5 years and had visited websites several times a day, with the exception of Stroke1, who mentioned visiting websites several times a week (Table 1). Stroke1, Stroke2 and Niece had never visited the Strokengine site (Table I).