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93 Acceptability and Usability of Tablet-Based Neuropsychological Tests among South African and Ugandan Adolescents With and Without HIV

Published online by Cambridge University Press:  21 December 2023

Christopher M Ferraris*
Affiliation:
HIV Center for Clinical and Behavioral Studies at the New York State Psychiatric Institute and Columbia University, New York, NY, USA.
Rebecca Dunayev
Affiliation:
Tufts University, Medford, MA, USA.
Nour Kanaan
Affiliation:
Duke University, Durham, NC, USA.
Courtney E Kirsch
Affiliation:
Pace University, New York, NY, USA.
Corey Morrison
Affiliation:
HIV Center for Clinical and Behavioral Studies at the New York State Psychiatric Institute and Columbia University, New York, NY, USA.
Nana Asiedu
Affiliation:
HIV Center for Clinical and Behavioral Studies at the New York State Psychiatric Institute and Columbia University, New York, NY, USA.
Daphne Tsapalas
Affiliation:
HIV Center for Clinical and Behavioral Studies at the New York State Psychiatric Institute and Columbia University, New York, NY, USA.
Anthony F Santoro
Affiliation:
HIV Center for Clinical and Behavioral Studies at the New York State Psychiatric Institute and Columbia University, New York, NY, USA.
Nicole J Phillips
Affiliation:
University of Cape Town, Cape Town, South Africa.
Jacqueline Hoare
Affiliation:
University of Cape Town, Cape Town, South Africa.
Angel Nanteza
Affiliation:
Butabika National Referral Mental Hospital, Kampala, Uganda.
Joy L Gumikiriza-Onoria
Affiliation:
Makerere University College of Health Sciences, Kampala, Uganda.
Victor Musiime
Affiliation:
Joint Clinical Research Centre, Kampala, Uganda.
Sahera Dirajlal-Fargo
Affiliation:
Case Western Reserve University, Cleveland, OH, USA
Reuben N Robbins
Affiliation:
HIV Center for Clinical and Behavioral Studies at the New York State Psychiatric Institute and Columbia University, New York, NY, USA.
*
Correspondence: Christopher M. Ferraris, HIV Center for Clinical and Behavioral Studies at the New York State Psychiatric Institute and Columbia University, christopher.ferraris@nyspi.columbia.edu
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Abstract

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Objective:

Neuropsychological (NP) tests are increasingly computerized, which automates testing, scoring, and administration. These innovations are well-suited for use in resource-limited settings, such as low- to middle- income countries (LMICs), which often lack specialized testing resources (e.g., trained staff, forms, norms, equipment). Despite this, there is a dearth of research on their acceptability and usability which could affect performance, particularly in LMICs with varying levels of access to computer technology. NeuroScreen is a tablet-based battery of tests assessing learning, memory, working memory, processing speed, executive functions, and motor speed. This study evaluated the acceptability and usability of NeuroScreen among two groups of LMIC adolescents with and without HIV from Cape Town, South Africa and Kampala, Uganda.

Participants and Methods:

Adolescents in Cape Town (n=131) and Kampala (n=80) completed NeuroScreen and questions about their use and ownership of, as well as comfort with computer technology and their experiences completing NeuroScreen. Participants rated their technology use -comfort with and ease-of-use of computers, tablets, smartphones, and NeuroScreen on a Likert-type scale: (1) Very Easy/Very Comfortable to (6) Very Difficult/Very Uncomfortable. For analyses, responses of Somewhat Easy/Comfortable to Very Easy/Comfortable were collapsed to codify comfort and ease. Descriptive statistics assessed technology use and experiences of using the NeuroScreen tool. A qualitative question asked how participants would feel receiving NeuroScreen routinely in the future; responses were coded as positive, negative, or neutral (e.g., “I would enjoy it”). Chi-squares assessed for group differences.

Results:

South African adolescents were 15.42 years on average, 50.3% male, and 49% were HIV-positive. Ugandan adolescents were 15.64 years on average, 50.6% male, and 54% HIVpositive. South African participants were more likely than Ugandan participants to have ever used a computer (71% vs. 49%; p<.005), or tablet (58% vs. 40%; p<.05), whereas smartphone use was similar (94% vs 87%). South African participants reported higher rates of comfort using a computer (86% vs. 46%; p<.001) and smartphone (96% vs. 88%; p<.05) compared to Ugandan participants. Ugandan adolescents rated using NeuroScreen as easier than South African adolescents (96% vs. 87%; p<.05).). Regarding within-sample differences by HIV status, Ugandan participants with HIV were less likely to have used a computer than participants without HIV (70% vs. 57%; p<.05, respectively).The Finger Tapping test was rated as the easiest by both South African (73%) and Ugandan (64%) participants. Trail Making was rated as the most difficult test among Ugandan participants (37%); 75% of South African participants reported no tasks as difficult followed by Finger Tapping as most difficult (8%). When asked about completing NeuroScreen at routine doctor’s visits, most South Africans (85%) and Ugandans (72%) responded positively.

Conclusions:

This study found that even with low prior tablet use and varying levels of comfort in using technology, South African and Ugandan adolescents rated NeuroScreen with high acceptability and usability. These data suggest that scaling up NeuroScreen in LMICs, where technology use might be limited, may be appropriate for adolescent populations. Further research should examine prior experience and comfort with tablets as predictors NeuroScreen test performance.

Type
Poster Session 05: Neuroimaging | Neurophysiology | Neurostimulation | Technology | Cross Cultural | Multiculturalism | Career Development
Copyright
Copyright © INS. Published by Cambridge University Press, 2023