Abstract
Background: The use of ambulatory biosensor devices for monitoring and coaching in forensic psychiatric settings yields high expectations for improved self-regulation of emotions and behaviour in clients and staff members. More so, if clients have mild intellectual disabilities, they might benefit from these biosensors as they are easy to use in every-day life, which ensures that clients can practice with the devices in multiple stress and arousal inducing situations. However, research on the use of biosensors in forensic psychiatry for clients with mild intellectual disabilities and their caretakers has been scarce. Besides that, although wearable biosensors show promise for healthcare, recent research showed that the acceptance and continuous use of wearable devices in consumers is not as was anticipated, probably due to low expectations. Objective: The main goal of the current study was to investigate the associations between and determinants of, the expectation of usability, the actually experienced usability and the intention for continuous use of biosensors. Methods: A total of 77 participants (N = 31 forensic clients with mild intellectual disabilities; N = 46 forensic staff members) participated in a one-week trial. Preceding the study, we selected four devices that were thought to benefit the participants in domains of self-regulation, physical health or sleep. Both qualitative and quantitative questionnaires were used that explored the determinants of usability, acceptance and continuous use of biosensors. Questionnaires consisted of the System Usability Scale (SUS), the Technology Acceptance Model (TAM)- questionnaire, and the Extended Expectation Confirmation Model (EECM)- questionnaire. Results: Only the experienced usability of the devices was associated with intended continuous use. Interestingly, the forensic clients scored higher on acceptance and intention for continuous use than staff members. In addition, moderate associations were found between usability with acceptance and continuous use. The qualitative questionnaires in general indicated that the devices were easy to use and gave clear information. Conclusions: Contrary to expectations it was the actual perceived usability of wearing a biosensor that was associated with continuous use, and to a much lesser extend the expectancy of usability. Clients scored higher on acceptance and intention for continuous use. It must be further investigated whether this is a true effect or due to a social desirability bias in the client group. However, it is interesting that clients scored higher on acceptance and continuous use as they might benefit from the ease of use of these devices and their continuing monitoring and coaching applications. For clients with mild intellectual disabilities it is especially important to develop easy to use biosensors, with a minimum requirement on cognitive capacity to increase usability, acceptance and continuous use.
