C-TOC - Cross-Cultural Review Panel

Notes by Matthew Brehmer, M.Sc Researcher, UBC Dept. of Computer Sc.

First Iteration: May 27, 2010

Introduction

• Setup of C-TOC prototype on Douglas College computer lab: no security/admin issues - macros working successfully
• refer to literacy education for seniors / immigrants - largely computer-based
• refer to UBC learning exchange w/ DT east side (apparently 40yo = senior)
• Claudia's introductory presentation
• cultural advisory coordinators: Kymberley Bontinen, Patricia Juvik, Sai Roshni (Priya) Raju; CHCP (centre for health and community partnerships) project manager: Marina Niks
• cultural advisory panel members (5, one missing)
  • Chinese, Japanese, South Asian, Southeast Asian, Latin American communities represented
  • Vivian Lam, Sayuri Sugawara, Kamaljit Kaur, Lam Dang, Karla Maranhao
  • recruited from community groups that interact w/ seniors in their respective communities
  • representative of health-care / extended care related positions, nursing, counselling
  • all members of the panel are immigrants

Interactive Prototype Session Notes

• users: 5 panel members, M. Niks, R. Hsiung, S. Raju, K. Bontinen, P. Juvik (10 total)
• difficulty realising what is a mockup and what is interactive (i.e. drop-down menus in introductory slides) - distinction may not be clear;
  • suggestion: use a warning label in the future?
• red prompts for referring to questionnaire not obvious enough - centre on screen rather than top-left?
  • suggestion: include pictures representative of each test on the questionnaire as reminders / in case they have skipped ahead and forgotten the questionnaire
• drag-and-drop habit hard to shake - everyone had difficulty with click-and-release moving of objects - some skipped the intro slide "move the blue circle into the square"; difficulty arose in sentence comprehension, which depended on this interaction; by this point many had developed an understanding of this interaction
  • will older users be similarly biased / used to traditional drag-and-drop? it requires constant motor pressure - did the panel understand this rationale for using click-and-release?
  • suggestion: try out traditional drag-and-drop in next prototype version and ask what is preferred
• pattern construction instructions not well understood by some users; dragging to other areas of the screen aside from the target zone; for instance, covering the source shape;
  • one user puts all the component shapes back into the source area after completing the target shape; not sure why?
• clicking on trails test not required but done by most users
  • suggestion: state that it is not necessary, provide animated instruction sequence
• click+drag on a shape misaligns the cursor, decoupling it from the shape causing confusion and the possibility for the shape to be dropped off-screen, or being unable to click-to-release shape unless the cursor is clicked on top of the shape;
  • not much to be done - a fault of the PPT macro
• square puzzles not fully interactive - some lines are still missing the drag/drop macro (#7 in particular)
• "stack on top" instruction in sentence comprehension has potential for multiple interpretations: some users layer shapes, some place shapes above one another on screen
• some go/no-go slides not advancing / hyperlink is broken and leads to an erroneous place in the slide deck
• sentence production instructions are still missing the additional instruction to "use as many words as possible"
• computers low on memory after opening 16 slide decks (will be resolved in non-ppt version)
• most participants finished session in 1h20min; final participant in 1h30min ("too long!")

Focus Group Notes

• Could handwriting be used as a diagnostic tool?
• general consensus: this test will work well for well-educated, high-income, well-integrated people
• problem w/ mouse drag-and-drop were vocalised
  • suggestion: avoid this by using touch-screens
• request for audio instructions as optional feature for all test instructions; other instruction formats could include a flow diagram / animated step-by-step instructions
• more practice sessions requested
• language throughout the tests needs to be overhauled, cultural-specific terms discarded; possible to translate into other languages?
  • Similarities test especially sensitive to language norms
  • cultural-specific names in item recognition test misleading (i.e. "stationery item")
  • suggestion: allow family members to translate, but not help with task
• provide an "I don't understand" option, a flag to de-validate a single test if necessary
• community centre use case scenario: group members help one another take the test rather than family/caregivers (peer support)
  • identified shame in cognitive illness, acknowledging it in the household, esp. in South Asian community
• suggestion: provide feedback on each test: descriptive time elapsed, # items correct, where you scored comparatively to pop. norms, past times taken
  • how to deliver potentially bad news over the net? instead direct to community resources regardless of test performance

• next panel meeting (late October 15/28/29?)
  • suggestion: provide a shorter evaluation version of the test for cultural advisory panel (i.e. less trials per test), provide web-accessible version of next prototype version in October, allow them to take + fill out survey from home - likely not in PPT, but in interactive programmed version (Flex?)
  • longer focus group next time, allow discussion on interactivity of each test
  • more focus group members to be recruited

Second Iteration: October, 2010

Introduction

• Setup of C-TOC prototype on Douglas College computer lab: no security/admin issues - macros working successfully
• refer to literacy education for seniors / immigrants - largely computer-based
• Claudia's introductory presentation
• cultural advisory coordinators: Kymberley Bontinen, Patricia Juvik, Sai Roshni (Priya) Raju; CHCP (centre for health and community partnerships) project manager: Marina Niks
• cultural advisory panel members (5, one missing)
  • Chinese, Japanese, South Asian, Southeast Asian, Latin American communities represented
  • Vivian Lam, Sayuri Sugawara, Kamaljit Kaur, Norma Sanchez, Gita Rafiee
  • recruited from community groups that interact w/ seniors in their respective communities
  • representative of health-care / extended care related positions, nursing, counselling

Interactive Prototype Session Notes

• users: 6 panel members, M. Niks, S. Raju, K. Bontinen, P. Juvik (10 total)
• observers: MB, HL, CJ, CT
• session started ~40 min late, finished ~45 min behind schedule (longest participant session 1h15min, shortest around 45min)

• intro/help menu/throughout CTOC
  • tooltips on buttons and links may be confusing
  • help menu has no exit button (must click on 'help' again to exit
  • by moving "back" from slide 2 to intro screen, you are unable to move forwards again;
  • too much text in help dialogs
  • pull-down menus not yet interactive
  • red questionnaire response cues are being missed - not obvious enough
  • "Click" here to proceed to next screen on page 1 - ambiguous as to where to click
  • yellow dot to click on unresponsive for some users
  • "are you still there?" prompt premature, timeout too soon

• PWP - after clicking on stimulus once, there is a long pause before feedback is given - potential source of spurious clicking or confusion
  • inform user of pause? mouse-over the name - only require 1 click?
  • on "correct" screen - show PWP before next trial?

• SDM - stopwatch image confusing - small clicking target - long pauses here

• SC - inconsistency in feedback given after practice problems: "correct" vs. "good"
  • "overlapping" vs. "on top"
  • obvious drag/drop issue

• SIM - no pictures for "fame" and "money" stimuli

• WR - no dedicated questionnaire page - tied to PWP

• MOS - need to click twice on misplaced object
  • would "click on object that doesn't belong" work?
  • contrast problem - potential need for hiring a graphic designer to design scenes and stimuli
  • bigger objects required

• TRA - automatic generation of lines on mouse-over confusing and likely invalid - people will click anyways; * numbers and letters culturally dependent

• SqP - one trial has impossible instruction
  • obviously difficult (for healthy adults)

• PC - wording instructions too small
  • reconstruction: "... like these" : instead of "."

• SP - dra/drop macro missing for some stimuli

• GNG - instructions too lengthy, not being re-read while they are subtly different

Focus Group Notes

• demographics: acceptability of CTOC in 80+ - computer literacy issues
• children will bring CTOC home to parents - dependent on culture and living situations - others will prefer company of peers in public spaces - knowledgeable peers or nurses
  • high trust and confidentiality among peers in some communities, others among family
• knowledge of English still an issue; more graphical instructions needed to address language issue;
  • provide a limited version w/ no language used, full version w/ language?
• high level of education, computer literacy, cultural knowledge required - can cultural content be more general?
• test could agitate depression or severe anxiety; can people break at will? a clear way to pause the test needed; test takes a lot of energy, very fatiguing
• consider a practice version of the test to be taken before undertaking the full version?
• adjusting test difficulty dynamically dependent on early performance - increasing difficulty may conflict w/ fatigue - confounding variables
  • "sorry try again" discontinuation rules after consecutive failures
• multiple clicks and pauses a hassle, spurious clicking - must strike a balance b/w always needing to click and not clicking
• moving objects very difficult
• variable scoring based on location of test-taking and current anxiety score?

• practice problems / instructions:
  • buttons top small throughout
  • use audio for instructions and feedback but not for test content - may be a distraction - optional audio
  • graphical sequence requested - demonstrating low level mouse clicks - accessible via help menu
  • graphical instructions well received, increased confidence and reduced stress - clear pictures
  • could instructions affect test validity? biases?
  • provide multiple options for different kinds of learners
  • itemise instructions to encourage re-reading of instructions with subtle differences (i.e. Go/No-Go)

• interruptions / distractions
  • physical noise - preventative, doctor's office scenario? use of sound-cancelling headphones? could still need to shut out loud conversation
  • resumption cues: could provide an automated summary, recap illustrations, one-step back
  • strategy: resume scoring on next trial - several cutoffs for "are you still there?" several restart points dependent on length of interruption
  • bathroom breaks should be considered

Third Iteration: February, 2011

Introduction

• Setup of C-TOC prototype on Douglas College computer lab: no security/admin issues - macros working successfully
• UBC attendees: MB, RH, HL, CL, WW (CJ ill)
• Robins's introductory presentation
• cultural advisory coordinators: Kymberley Bontinen, Patricia Juvik, Sai Roshni (Priya) Raju, Marjory Ditmars; CHCP (centre for health and community partnerships) project manager: Marina Niks
• cultural advisory panel members (4, one missing)
  • South Asian, Southeast Asian, Persian, Latin American communities represented
  • Kamaljit Kaur, Norma Sanchez, Gita Rafiee, Fariyal Dhirani
  • recruited from community groups that interact w/ seniors in their respective communities
  • representative of health-care / extended care related positions, nursing, counselling

Interactive Prototype Session Notes

• users: 4 panel members, CHCP coordinators (6 total)
• observers: MB, HL, CL, RH, WW
• longest participant session 1h15min, shortest around 1hr
• delayed start (surveys, headphones needed to be distributed)

• General / Navigation
  • button affordances required throughout (mouseOver, mouseDown, disabled feedback, audible click on mouseDown);
    • ppt hyperlink mouseOver dialogs are shown currently (confusing, meaningless text is shown)
  • consistent button UI: colour, text colour, gradients, border, font, font size, bevel, etc.
    • many nav. buttons have poor-contrast black text on blue background.
    • help buttons are different from nav. buttons
    • I suggest a permanent control bar with small set of icons for help and navigation, visible throughout the test; pause button, progress bar visible between tests;
  • click to pick up, drag, and click to drop instructions still insufficient; default drag-drop behaviour overrides; will be eliminated in programmed version;
  • computer-literate-biased terminology used throughout: "Back", "Icon", potentially more?

• Introduction
  • drop-down menus still not implemented (explained by small dialog)

• Help

• Picture-Word Pairs

• Symbol-Digit Matching

• Similarities

• Word Recognition

• Pattern Construction

• Sentence Comprehension

• Trails

• Arithmetic

• Pattern Reconstruction

• Misplaced Object Search

• Sentence Production

• Square Puzzles

• Go No-Go

• Misplaced Object Recall

• Conclusion

Focus Group Notes

• acceptability

• context of use

• language

• general usability

• audio

• practice problems / instructions:

• interruptions / distractions

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-- MatthewBrehmer - 01 Jun 2010