INS NYC 2024 Program

Poster	Poster Session 11 Program Schedule 02/17/2024 10:45 am - 12:00 pm Room: Majestic Complex (Posters 61-120) Poster Session 11: Cultural Neuropsychology \| Education/Training \| Professional Practice Issues Final Abstract #103 Considerations for Computerized Test Adaptation in Low- and Middle-Income Countries Daphne Tsapalas, HIV Center for Clinical and Behavioral Studies, Columbia University and New York State Psychiatric Institute, New York City, United States Kaylie Springer, Wartburg College, Waverly, United States Courtney Kirsch, HIV Center for Clinical and Behavioral Studies, Columbia University and New York State Psychiatric Institute, New York City, United States Sriya Dupati, Duke University, Durham, United States Angel Nanteza, Butabika National Referral Mental Hospital, Kampala, Uganda Christopher Ferraris, HIV Center for Clinical and Behavioral Studies, Columbia University and New York State Psychiatric Institute, New York City, United States Nana Asiedu, HIV Center for Clinical and Behavioral Studies, Columbia University and New York State Psychiatric Institute, New York City, United States Mei Tan, HIV Center for Clinical and Behavioral Studies, Columbia University and New York State Psychiatric Institute, New York City, United States Joy Gumikiriza-Onoria, Makerere University College of Health Sciences, School of Medicine, Department of Psychiatry, Kampala, Uganda Reuben Robbins, HIV Center for Clinical and Behavioral Studies, Columbia University and New York State Psychiatric Institute, New York City, United States Category: Cross Cultural Neuropsychology/ Clinical Cultural Neuroscience Keyword 1: cross-cultural issues Keyword 2: test development Keyword 3: technology Objective: Modern neuropsychological (NP) testing increasingly relies on delivery through computerized platforms such as touchscreen tablets. Tablet-based NP tests may increase testing accessibility in low- and middle-income countries (LMICs) that lack resources for traditional non-computerized testing. However, many LMIC populations have limited experience with NP testing and tablets. Little research has examined the understandability and usability of tablet-based NP tests in LMICs, such as Uganda, where the current study took place. We examined Ugandan youth understandability and usability of tablet-based NP tests. Participants and Methods: Using a novel Adapted Cognitive Interview (ACI) protocol, we video-recorded the hands of 13 Ugandan youth (6-16 years old; Mage = 10.5) completing four processing speed tests (Trailmaking [TM] 1 and 3 and Visual Discrimination [VD] 1 and 2), and one executive functioning test (TM 2) in the NeuroScreen tablet-based NP test battery. Videos were analyzed using behavioral observation codebooks focused on hand-tablet interactions. Codes included unexpected behaviors, such as “Pauses at circle”, “Incorrect starting circle”, “Twists hand”, “Drags finger”, and “Insufficient pressure” (i.e., tablet not registering touch). All video-recordings were coded by a study member; a sample of recordings underwent consensus review to establish agreement. Results: About half (6 of 13) of participants reported having used a tablet before. Most participants were able to complete most tests according to the instructions and without difficulty using the tablet. Some unexpected behaviors related to test understandability were observed. Participants in 14 of 39 (36%) completed TM tests paused mid-test. Sequencing errors occurred in 9 of 39 (23%) completed TM tests, 5 of which had ≥4 errors in one sequence. In 9 of 26 (35%) completed VD tests, participants pressed incorrect response choice buttons before, or instead of, pressing the correct response buttons. Regarding tablet usability, in 10 of 39 (26%) completed TM tests participants pressed slightly outside the perimeter of the circles such that the tablet did not register their touch. Participants were observed twisting their hands while connecting TM circles in 11 of 39 (28%) completed TM tests due to their hand blocking the screen. In 7 of 39 (18%) completed TM tests, participants dragged their fingers on the tablet screen, effectively slowing their performance. In contrast, one participant’s touches did not elicit a response on the tablet screen. At least one participant traced off-screen and another participant’s hand rested on the screen such that their responses were not recorded. Conclusions: Overall, participants completed tests in accordance with test instructions and were able to use the tablets as instructed, however, some unexpected issues with test understandability and tablet usability were observed. Our findings highlight the importance of understandability and usability evaluation for computerized NP tests in LMICs and pinpoint potential adaptations that may improve understandability and usability, accounting for limited experience using tablet devices. Using ACI with video-coding can aid in the development and adaptation of computerized NP tests for populations with both limited access to computers and experience taking NP tests.

Poster

02/17/2024
10:45 am - 12:00 pm
Room: Majestic Complex (Posters 61-120)

Poster Session 11: Cultural Neuropsychology | Education/Training | Professional Practice Issues

Final Abstract #103

Considerations for Computerized Test Adaptation in Low- and Middle-Income Countries

Daphne Tsapalas, HIV Center for Clinical and Behavioral Studies, Columbia University and New York State Psychiatric Institute, New York City, United States
Kaylie Springer, Wartburg College, Waverly, United States
Courtney Kirsch, HIV Center for Clinical and Behavioral Studies, Columbia University and New York State Psychiatric Institute, New York City, United States
Sriya Dupati, Duke University, Durham, United States
Angel Nanteza, Butabika National Referral Mental Hospital, Kampala, Uganda
Christopher Ferraris, HIV Center for Clinical and Behavioral Studies, Columbia University and New York State Psychiatric Institute, New York City, United States
Nana Asiedu, HIV Center for Clinical and Behavioral Studies, Columbia University and New York State Psychiatric Institute, New York City, United States
Mei Tan, HIV Center for Clinical and Behavioral Studies, Columbia University and New York State Psychiatric Institute, New York City, United States
Joy Gumikiriza-Onoria, Makerere University College of Health Sciences, School of Medicine, Department of Psychiatry, Kampala, Uganda
Reuben Robbins, HIV Center for Clinical and Behavioral Studies, Columbia University and New York State Psychiatric Institute, New York City, United States

Category: Cross Cultural Neuropsychology/ Clinical Cultural Neuroscience

Keyword 1: cross-cultural issues
Keyword 2: test development
Keyword 3: technology

Objective:

Modern neuropsychological (NP) testing increasingly relies on delivery through computerized platforms such as touchscreen tablets. Tablet-based NP tests may increase testing accessibility in low- and middle-income countries (LMICs) that lack resources for traditional non-computerized testing. However, many LMIC populations have limited experience with NP testing and tablets. Little research has examined the understandability and usability of tablet-based NP tests in LMICs, such as Uganda, where the current study took place. We examined Ugandan youth understandability and usability of tablet-based NP tests.

Participants and Methods:

Using a novel Adapted Cognitive Interview (ACI) protocol, we video-recorded the hands of 13 Ugandan youth (6-16 years old; Mage = 10.5) completing four processing speed tests (Trailmaking [TM] 1 and 3 and Visual Discrimination [VD] 1 and 2), and one executive functioning test (TM 2) in the NeuroScreen tablet-based NP test battery. Videos were analyzed using behavioral observation codebooks focused on hand-tablet interactions. Codes included unexpected behaviors, such as “Pauses at circle”, “Incorrect starting circle”, “Twists hand”, “Drags finger”, and “Insufficient pressure” (i.e., tablet not registering touch). All video-recordings were coded by a study member; a sample of recordings underwent consensus review to establish agreement.

Results:

About half (6 of 13) of participants reported having used a tablet before. Most participants were able to complete most tests according to the instructions and without difficulty using the tablet. Some unexpected behaviors related to test understandability were observed. Participants in 14 of 39 (36%) completed TM tests paused mid-test. Sequencing errors occurred in 9 of 39 (23%) completed TM tests, 5 of which had ≥4 errors in one sequence. In 9 of 26 (35%) completed VD tests, participants pressed incorrect response choice buttons before, or instead of, pressing the correct response buttons. Regarding tablet usability, in 10 of 39 (26%) completed TM tests participants pressed slightly outside the perimeter of the circles such that the tablet did not register their touch. Participants were observed twisting their hands while connecting TM circles in 11 of 39 (28%) completed TM tests due to their hand blocking the screen. In 7 of 39 (18%) completed TM tests, participants dragged their fingers on the tablet screen, effectively slowing their performance. In contrast, one participant’s touches did not elicit a response on the tablet screen. At least one participant traced off-screen and another participant’s hand rested on the screen such that their responses were not recorded.

Conclusions:

Overall, participants completed tests in accordance with test instructions and were able to use the tablets as instructed, however, some unexpected issues with test understandability and tablet usability were observed. Our findings highlight the importance of understandability and usability evaluation for computerized NP tests in LMICs and pinpoint potential adaptations that may improve understandability and usability, accounting for limited experience using tablet devices. Using ACI with video-coding can aid in the development and adaptation of computerized NP tests for populations with both limited access to computers and experience taking NP tests.