Data, Data Everywhere, and Still Too Hard to Link: Insights from User Interactions with Diabetes Apps

For those with chronic conditions, such as Type 1 diabetes, smartphone apps offer the promise of an affordable, convenient, and personalized disease management tool. How- ever, despite significant academic research and commercial development in this area, diabetes apps still show low adoption rates and underwhelming clinical outcomes. Through user-interaction sessions with 16 people with Type 1 diabetes, we provide evidence that commonly used interfaces for diabetes self-management apps, while providing certain benefits, can fail to explicitly address the cognitive and emotional requirements of users. From analysis of these sessions with eight such user interface designs, we report on user requirements, as well as interface benefits, limitations, and then discuss the implications of these findings. Finally, with the goal of improving these apps, we identify 3 questions for designers, and review for each in turn: current shortcomings, relevant approaches, exposed challenges, and potential solutions

Making sense of personal health information: Challenges for information visualization

This article presents a systematic review of the literature on information visualization for making sense of personal health information. Based on this review, five application themes were identified: treatment planning, examination of patients' medical records, representation of pedigrees and family history, communication and shared decision making, and life management and health monitoring. While there are recognized design challenges associated with each of these themes, such as how best to represent data visually and integrate qualitative and quantitative information, other challenges and opportunities have received little attention to date. In this article, we highlight, in particular, the opportunities for supporting people in better understanding their own illnesses and making sense of their health conditions in order to manage them more effectively

Behavior Change Apps for Gestational Diabetes Management : Exploring Desirable Features

Publisher Copyright: © 2021 The Author(s). Published with license by Taylor & Francis Group, LLC.Gestational diabetes mellitus (GDM) has considerable and increasing health effects as it raises both the mother’s and offspring’s risk for short- and long-term health problems. GDM can usually be treated with a healthier lifestyle, such as appropriate dietary modifications and engaging insufficient physical activity. While telemedicine interventions requiring weekly or more frequent feedback from health care professionals have shown the potential to improve glycemic control amongst women with GDM, apps without extensive input from health care professionals are limited and have not shown to be effective. We aimed to improve the efficacy of GDM self-management apps by exploring desirable features in a review. We derived six desirable features from the multidisciplinary literature and we evaluated the state of implementation of these features in existing GDM apps. The results showed that features for increasing competence to manage GDM and for providing social support were largely lacking.Peer reviewe

Social Interface and Interaction Design for Group Recommender Systems

Group recommender systems suggest items of interest to a group of people. Traditionally, group recommenders provide recommendations by aggregation the group membersâ preferences. Nowadays, there is a trend of decentralized group recommendation process that leverages the group dynamics and reaches the recommendation goal by allowing group members to influence and persuade each other. So far, the research on group recommender systems mainly focuses on the how to optimize the preference aggregation and enhance the accuracy of recommendations. There is a lack of emphasis on the usersâ social experience, such as interpersonal relationship, emotion exchange, group dynamics, etc. We define the space where user-user interaction occurs in social software as social interfaces. In this thesis, we aim to design and evaluate social interfaces and interactions for group recommender systems. We start with surveying the state-of-the-art of user issues in group recommender systems and interface and interaction design in the broad sense of social applications. We present ten applications and their evaluation via user studies, which lead to a preliminary set of social interface and interaction design guidelines. Based on these guidelines, we develop group recommender systems to investigate the design issues. We then study social interfaces for group recommender systems. We present the design and development ofan experimental platformcalled GroupFun that recommends music to a group of users. We then study the impact of emotion awareness in group recommender systems. More concretely, we design and implement two different methods for emotion awareness: CoFeel and ACTI that visualize emotions using color wheels, and empatheticons that present emotions using dynamic animations of usersâ profile pictures. Our user studies show that emotion awareness tools can help users familiarize with other membersâ preferences, enhance their interpersonal relationships, increase the sense of connectedness in distributed social interactions, and result in higher consensus and satisfaction in group recommendations. We also examine social interactions for persuasive technologies. We design and develop a mobile social game called HealthyTogether that enables dyads to exercise together. With this platform, we study how different social interaction mechanisms, such as social accountability, competition, cooperation, and team spirits, can help usersmotivate and influence each other in physical exercises. We conducted three user studies lasting for up to ten weeks with a total of 80 users. Being accountable for each otherâs performance enhances interpersonal relationships. Supporting users to cooperate on health goals significantly improve their number of steps. When designing competition in the applications, it is crucial to help users to choose comparable buddies. Finally, teamwork in exercises not only helps users to increase their steps, but also help them sustain in exercise. Furthermore, we present an evaluation framework for social persuasive applications. The framework aims at modeling how social strategies and social influence affect user attitudes and behavioral intentions towards the system. Finally, we derive a set of guidelines for social interface and interaction design for group recommender systems. The guidelines can help researchers and practitioners effectively design social experiences for not only group recommenders but also other social software [...

Health and activity monitoring to support the self-management of chronic diseases of lifestyle using smart devices

Chronic diseases of lifestyle (CDLs) are non-infectious medical conditions, such as diabetes, cardiovascular disease and cancer. These conditions are the second leading cause of death and disease in Africa. Failure to modify primary risk factors, such as an unhealthy diet, lack of physical activity and tobacco use, can give rise to intermediate risk factors such as hypertension and obesity, which predispose individuals to CDLs. The aim of the research was to investigate the use of smart devices to facilitate the self-management of health and health behaviours. The Health Action Process Approach (HAPA) model of health behaviour change was adopted, which focuses on the correction of modifiable risk factors. Two smart devices were selected, namely the Fitbit Charge 2 and Fitbit Aria, which monitor specific physiological information. The Fitbit Charge 2 can determine health activity, and the Fitbit Aria can determine the weight, body mass index (BMI) and body fat percentage of an individual. A field study was conducted with 22 participants (11 males and 11 females) to evaluate and determine the effectiveness of the smart devices. The participants were sampled from Nelson Mandela University staff and were aged between 30 and 60 years of age. The field study was conducted over two weeks in two one-week long phases. The first phase was used to obtain subjective data (using a lifestyle questionnaire), and objective health data (collected by the smart devices) from the participants. The purpose of the first phase was to form intentions. The second phase was the goal setting phase, where each participant was assisted in setting manageable personal goals. The results show that the smart devices used in the research could be used to provide motivation and monitor health data to support self-management of CDLs. The use of these smart devices was included in an updated HAPA model

Supporting Diabetes Self-Management with Ubiquitous Computing Technologies: A User-Centered Inquiry

Ubiquitous computing technologies offer opportunities to improve treatments for chronic health conditions. Type 1 diabetes is a compelling use-case for such approaches, given its severity, and need for individuals to make frequent care decisions, informed by complex data. However, current apps, typically based on effortful reflection on collected data, generally show poor adoption, lack vital cognitive and emotional support, and are poorly tailored to users’ actual diabetes decision making processes. This thesis investigates how diabetes apps can be improved from a user-centered perspective. An initial questionnaire-based study investigated how well existing diabetes apps meet user needs. Perceived benefits, limitations, and reasons for low adoption rates were identified. A talk-aloud study of detailed user interactions with diabetes logging apps was conducted to characterize the benefits and limitations of diverse UI elements for T1 diabetes management, and to more precisely identify wider problems with current interaction designs. This led to positing a refined version of Mamykina et al.’s model for diabetes self-management, to account for observed practices, whereby the previously accepted habitual and sensemaking cognitive states are augmented by a posited ‘fluid contextual reasoning’ (FCR) mode, which allows multiple contextual factors to be balanced for dynamic course correction when navigating complex situations, using previously learned knowledge. To investigate user perceptions of the levels and kinds of monitoring anticipated in next generation diabetes decision support systems, a 4-week technology probe, in which participants used multiple networked devices and external data aggregation, was used to frame requirements for user-centered development of such future systems. Integrating all of the above work, an iterative design process was undertaken to create DUETS, a card-based system to facilitate reflection by designers, users, and other stakeholders on diabetes support management systems. The resulting tool and method were then implemented and evaluated through structured sessions with stakeholder focus groups

Aiding information security decisions with human factors using quantitative and qualitative techniques

Phd ThesisThe Information Security Decision Making Process is comprised of an extremely complex and dynamic set of sub-tasks, sub-goals and inter-disciplinary practices. In order to be effective and appropriate, this process must balance both the requirements of the stakeholder as well as the users within the system. Without careful consideration of users’ behaviours and preferences, interventions are often seen as obstacles towards productivity and subsequently circumvented or simply not adhered to. The approach detailed herein requires an intimate knowledge of both Information Security and Human Behaviour. An effective security policy must adequately protect a given set of assets (human and non-human) or systems as well as preserve maximal productivity. Companies rely on their Intellectual Property Rights which are often stored in a digital format. This presents a plethora of issues regarding security, access management and locality (whether on or off the premises). Furthermore, there is the added complexity of employees and how they operate within this environment (a subset of compliance, competence and policy). With the continued increase in consumerisation, more specifically the rise of Bring Your Own Device, there is a significant threat towards data security that persists outside of the typical working environment. This trend enables employees to access and transfer corporate assets remotely but in doing so creates a conflict over identity, ownership and data management. The governance of these activities creates an extremely complex problem space which requires the need to balance these requirements relying on an accurate assessment of risk, identification of security vulnerabilities and knowledge pertaining to the behaviour of employees. The risks to company assets can be estimated by the analysis of the following issues: • Threats to your assets. These are unwanted events that could cause the deliberate or accidental loss, damage or misuse of the assets. • Vulnerabilities. How susceptible your assets are to attack. • Impact. The magnitude of the potential loss or the seriousness of the event. The ability to quantify and accurately represent these variables is critical in developing, implementing and supporting a successful security policy. The dissertation is structured as follows. Chapter 1 provides an abstract overview of the problem space and highlights our aims, objectives and publications. Chapter 2 details an in-depth literature review of the cross-disciplinary problem space. This involves both the analysis of industry standards, practices and reports as well as a summary of academic literature pertaining to theoretical frameworks and simulations for discussion. Chapter 3 introduces our problem space and documents the rationale for designing our methodology. Each successive chapter (4, 5, & 6) documents a separate investigative strategy for populating specific data sets with respect to the behaviours and practices highlighted from our pilot study and CISO interaction. This provides the rationale behind each approach as well as a documented implementation and evaluation of our experimental design with reference to publications in the field. Chapter 7 documents our modelling strategy and highlights the extensions we propose to the BPMN 2.0 formalism. Chapter 8 concludes our work with reference to our contributions, limitations and the direction of future study

The few touch digital diabetes diary : user-involved design of mobile self-help tools for peoplewith diabetes

Paper number 2, 4, 5 and 7 are not available in Munin, due to publishers' restrictions: 2. Årsand E, and Demiris G.: "User-Centered Methods for Designing Patient-Centric Self-Help Tools", Informatics for Health and Social Care, 2008 Vol. 33, No. 3, Pages 158-169 (Informa Healthcare). Available at http://dx.doi.org/10.1080/17538150802457562 4. Årsand E, Olsen OA, Varmedal R, Mortensen W, and Hartvigsen G.: "A System for Monitoring Physical Activity Data Among People with Type 2 Diabetes", pages 173-178 in S.K. Andersen, et.al. (eds.) "eHealth Beyond the Horizon - Get IT There", Proceedings of MIE2008, Studies in Health Technology and Informatics, Volume 136, May 2008, ISBN: 978-1-58603-864-9 5. Årsand E, Tufano JT, Ralston J, and Hjortdahl P.: "Designing Mobile Dietary Management Support Technologies for People with Diabetes", Journal of Telemedicine and Telecare, 2008 Volume 14, Number 7, Pp. 329-332 (Royal Society of Medicine Press). Available at http://dx.doi.org/10.1258/jtt.2008.007001 7. Årsand E, Walseth OA, Andersson N, Fernando R, Granberg O, Bellika JG, and Hartvigsen G.: "Using Blood Glucose Data as an Indicator for Epidemic Disease Outbreaks", pages 199-204 in R. Engelbrecht et.al. (eds.): "Connecting Medical Informatics and Bio-Informatics", Proceedings of MIE2005, Studies in Health Technology and Informatics, Volume 116, August 2005, ISBN: 978-1-58603-549-5. Check availabilityParadoxically, the technological revolution that has created a vast health problem due to a drastic change in lifestyle also holds great potential for individuals to take better care of their own health. The first consequence is not addressed in this dissertation, but the second represents the focus of the work presented, namely utilizing ICT to support self-management of individual health challenges. As long as only 35% of the patients in Norway achieve the International Diabetes Federation‟s goal for blood glucose (HbA1c), actions and activities to improve blood glucose control and related factors are needed. The presented work focuses on the development and integration of alternative sensor systems for blood glucose and physical activity, and a fast and effortless method for recording food habits. Various user-interface concepts running on a mobile terminal constitute a digital diabetes diary, and the total concept is referred to as the “Few Touch application”. The overall aim of this PhD project is to generate knowledge about how a mobile tool can be designed for supporting lifestyle changes among people with diabetes. Applying technologies and methods from the informatics field has contributed to improved insight into this issue. Conversely, addressing the concrete use cases for people with diabetes has resulted in the achievement of ICT designs that have been appreciated by the cohorts involved. Cooperation with three different groups of patients with diabetes over several years and various methods and theories founded in computer science, medical informatics, and telemedicine have been combined in design and research on patient-oriented aids. The blood glucose Bluetooth adapter, the step counter, and the nutrition habit registration system that have been developed were all novel and to my knowledge unique designs at the time they were first tested, and this still applies to the latter two. Whether it can be claimed that the total concept presented, the Few Touch application, will increase quality of life, is up to future research and large-scale tests of the system to answer. However, results from the Type 2 diabetes half-year study showed that several of the participants did adjust their medication, food habits and/or physical activity due to use of the application

From persuasion to negotiation in health promoting technology

Over recent years, designing technologies to promote health-related behavioural change has been an area of growing interest in HCI. Given the prevalence of self-monitoring and social facilitation in emerging designs, the assumption appears to be that increasing an individual’s awareness of his or her behaviour and the behaviour of others will promote behavioural change. This thesis argues that while this is true to some extent, this represents a somewhat naive view of how individuals come to make decisions regarding their health-related behaviours. Three qualitative studies within distinct health domains illustrate the complex nature of health-related behavioural change. Weight Management was an inherently social activity, albeit subject to selective disclosure and incremental participation. Individuals were generally motivated by appearance rather than health, implementing change based on exposure and orientation to alternative strategies. In Families at Risk, caregivers were highly motivated by a desire to safeguard the health of their children but were restricted by a lack of financial and strategic resources. Lack of trust and a transient community contributed to social isolation, thus inhibiting opportunities for collaboration. In Cardiac Rehabilitation, behavioural change efforts were prompted by an acute health crisis and guided by health professionals. However, behavioural change efforts were sometimes restricted by a desire to return to normal, tensions arising when what was considered normal was composed of risk behaviours. Family involvement varied greatly, ranging from disregard to facilitating change, and a desire for independence and ownership of the rehabilitation sometimes restricted the active involvement of peers. Informed by the findings of these studies this thesis highlights the strengths and limitations of current technological approaches to promoting behavioural change, provides implications for design, and supported by the sociomedical literature, identifies alternative avenues of technological innovation. The thesis reflects on technology’s role in health-related behavioural change and considers associated ethical implications. Overall, the main contribution of this thesis is a reframing of the problem of promoting health-related behavioural change as more than a matter of behavioural awareness and personal motivation. While it is understandable that technologists would look to the clinical domain to inform initial investigations in this area, this thesis argues that technologists should be cautious about blindly adopting its prescriptive paradigm. As an alternative to persuasion, this thesis offers negotiation as a potential model for future innovations in this area