TY  - JOUR
AU  - Dauber-Decker, Katherine L
AU  - Feldstein, David
AU  - Hess, Rachel
AU  - Mann, Devin
AU  - Kim, Eun Ji
AU  - Gautam-Goyal, Pranisha
AU  - Solomon, Jeffrey
AU  - Khan, Sundas
AU  - Malik, Fatima
AU  - Xu, Lynn
AU  - Huffman, Ainsley
AU  - Smith, Paul D
AU  - Halm, Wendy
AU  - Yuroff, Alice
AU  - Richardson, Safiya
PY  - 2025
DA  - 2025/2/18
TI  - Snowball Group Usability Testing for Rapid and Iterative Multisite Tool Development: Method Development Study
JO  - JMIR Form Res
SP  - e55316
VL  - 9
KW  - clinical decision support
KW  - CDS
KW  - decision aid
KW  - clinical aid
KW  - cough
KW  - sore throat
KW  - strep pharyngitis
KW  - snowball group usability testing
KW  - snowball group
KW  - usability testing
AB  - Background: Usability testing is valuable for assessing a new tool or system’s usefulness and ease-of-use. Several established methods of usability testing exist, including think-aloud testing. Although usability testing has been shown to be crucial for successful clinical decision support (CDS) tool development, it is often difficult to conduct across multisite development projects due to its time- and labor-intensiveness, cost, and the skills required to conduct the testing. Objective: Our objective was to develop a new method of usability testing that would enable efficient acquisition and dissemination of results among multiple sites. We sought to address the existing barriers to successfully completing usability testing during CDS tool development. Methods: We combined individual think-aloud testing and focus groups into one session and performed sessions serially across 4 sites (snowball group usability testing) to assess the usability of two CDS tools designed for use by nurses in primary and urgent care settings. We recorded each session and took notes in a standardized format. Each site shared feedback from their individual sessions with the other sites in the study so that they could incorporate that feedback into their tools prior to their own testing sessions. Results: The group testing and snowballing components of our new usability testing method proved to be highly beneficial. We identified 3 main benefits of snowball group usability testing. First, by interviewing several participants in a single session rather than individuals over the course of weeks, each site was able to quickly obtain their usability feedback. Second, combining the individualized think-aloud component with a focus group component in the same session helped study teams to more easily notice similarities in feedback among participants and to discuss and act upon suggestions efficiently. Third, conducting usability testing in series across sites allowed study teams to incorporate feedback based on previous sites’ sessions prior to conducting their own testing. Conclusions: Snowball group usability testing provides an efficient method of obtaining multisite feedback on newly developed tools and systems, while addressing barriers typically associated with traditional usability testing methods. This method can be applied to test a wide variety of tools, including CDS tools, prior to launch so that they can be efficiently optimized. Trial Registration: Clinicaltrials.gov NCT04255303; https://clinicaltrials.gov/study/NCT04255303 
SN  - 2561-326X
UR  - https://formative.jmir.org/2025/1/e55316
UR  - https://doi.org/10.2196/55316
DO  - 10.2196/55316
ID  - info:doi/10.2196/55316
ER  -