Eye-tracking retrospective think-aloud as a novel approach for a usability evaluation

Hwayoung Cho*, Dakota Powell, Adrienne Pichon, Lisa M. Kuhns, Robert Garofalo, Rebecca Schnall

*Corresponding author for this work

Research output: Contribution to journalArticlepeer-review

34 Scopus citations


Objective: To report on the use of an eye-tracking retrospective think-aloud for usability evaluation and to describe its application in assessing the usability of a mobile health app. Materials and Methods: We used an eye-tracking retrospective think-aloud to evaluate the usability of an HIV prevention mobile app among 20 young men (15–18 years) in New York City, NY; Birmingham, AL; and Chicago, IL. Task performance metrics, critical errors, a task completion rate per participant, and a task completion rate per task, were measured. Eye-tracking metrics including fixation, saccades, time to first fixation, time spent, and revisits were measured and compared among participants with/without a critical error. Results: Using task performance analysis, we identified 19 critical errors on four activities, and of those, two activities had a task completion rate of less than 78%. To better understand these usability issues, we thoroughly analyzed participants’ corresponding eye movements and verbal comments using an in-depth problem analysis. In areas of interest created for the activity with critical usability problems, there were significant differences in time spent (p = 0.008), revisits (p = 0.004), and total numbers of fixations (p = 0.007) by participants with/without a critical error. The overall mean score of perceived usability rated by the Health IT Usability Evaluation Scale was 4.64 (SD = 0.33), reflecting strong usability of the app. Discussion and Conclusion: An eye-tracking retrospective think-aloud enabled us to identify critical usability problems as well as gain an in-depth understanding of the usability issues related to interactions between end-users and the app. Findings from this study highlight the utility of an eye-tracking retrospective think-aloud in consumer health usability evaluation research.

Original languageEnglish (US)
Pages (from-to)366-373
Number of pages8
JournalInternational Journal of Medical Informatics
StatePublished - Sep 2019


  • Eye movement measurements
  • Eye movements
  • Eye-tracking
  • Health IT
  • Information technology
  • Mobile applications
  • Mobile health
  • Usability evaluation

ASJC Scopus subject areas

  • Health Informatics


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