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Article – GEMS card deck

Usable tools for usability research

eHealth Living and Learning Lab Amsterdam

Development of a visual questionnaire for evaluating usability in health technologies

Published on 09-09-2025

Digital health technologies (DHTs), such as apps, monitoring systems, and home-based medical devices, are becoming a normal part of healthcare. They can help people manage their health at home, but not everyone finds them easy to use.

Many existing questionnaires that measure usability rely on complex words and technical language. This makes them hard to understand for people with lower health or digital literacy. As a result, their voices are often missing from usability evaluations, eventhough they are among the people who could benefit most.

A new approach: Visual Question Cards

To address this, we developed a visual questionnaire in the form of a card deck. Instead of only written questions, each card combines:

The cards cover common usability themes, such as:

By showing images alongside plain-language questions, the cards make it easier for people with different levels of literacy and cognitive abilities to share their experiences.

Co-Production with Users

This tool was created together with the people it is meant to serve. We worked in small group sessions with:

Participants gave feedback on the clarity of words and visuals, suggesting improvements. For example, while a clock was clear to represent time, an hourglass was sometimes mistaken for a coffee maker. Based on such feedback, we refined the images and texts to be more intuitive and relevant.

Why It Matters

This card-based questionnaire does more than collect ratings. It starts conversations about technology use and helps uncover barriers that might otherwise stay hidden. Healthcare professionals can use the cards to better understand a patient’s comfort level with technology, guiding decisions about care at home.

Next Steps

The card deck is currently a first working prototype. Further research will test it with a larger group of older adults, compare it to existing questionnaires, and examine its reliability. The long-term goal is to create a validated, accessible tool that makes usability testing fairer and more inclusive.

By making evaluations easier to understand, we can ensure that digital health technologies are developed for all users.

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