Concealing or Revealing Mobile Medical Devices? Designing for Onstage and Offstage Presentation

Adults with Type 1 Diabetes have choices regarding the technology they use to self-manage their chronic condition. They can use glucose meters, insulin pumps, smartphone apps, and other technologies to support their everyday care. However, little is known about how their social lives might influence what they adopt or how they use technologies. A multi-method study was conducted to examine contextual factors that influence their technology use. While individual differences play a large role in everyday use, social factors were also found to influence use. For example, people can hide their devices in uncertain social situations or show them off to achieve a purpose. We frame these social behaviours using Goffman's theatre metaphor of onstage and offstage behaviour, and discuss how this kind of analysis can inform the design of future mobile medical devices for self-management of chronic conditions

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

Mobile technologies for chronic condition management.

The management of long term chronic conditions is a complex and challenging task. The process relies on individuals engaging in regular recording of factors that affect their health. Yet currently, the mobile tools that people carry with them are not being fully utilised to assist in this process. This Thesis reports on research that has been completed to understand the role that mobile technologies can have in supporting people with chronic conditions. An individual engaging in personal monitoring is concerned with the data they collect, not the process used to capture the data. The results of the research conducted contribute to an advancement of knowledge around how mobile technologies can assist in personal reflection on health information to provide greater understanding of chronic disease management This understanding of the role of reflection in chronic condition management can then be used as a platform to improve the mobile interventions in future implementations. These findings are arrived at by conducting an initial investigation into the usage of existing health monitoring devices and an evaluation of these devices is detailed. The results of this early work suggests there exists a gap between real practice and the role that mobile technologies can play in assisting with the process. A deeper understanding of the management practices of people with diabetes is then achieved through a set of interviews with individuals with diabetes. The findings then define a model of chronic disease management, named the 'Diabetes Management Cycle.' Following the definition of the cycle, a mobile application was implemented and deployed during a four week evaluation with individuals with type 1 diabetes. This system was designed to support existing management practices and implemented simple methods of information capture. A second application was then developed to enable increased monitoring and subsequent reflection amongst individuals with cardiovascular conditions. The application was deployed in a six week in-situ evaluation and it was discovered a personalised 'tagging' mechanism allowed for the discovery of patterns affecting health. Based on the findings of the studies, the Thesis concludes by presenting definitions of ready- to-hand in the short- and long-term contexts of mobile health management. These ready-to-hand guidelines provide a platform for future research projects to build upon

Individual differences and contextual factors influence the experience and practice of self-care with type 1 diabetes technologies

Adults with Type 1 Diabetes have choices about what technologies to use to self-manage their chronic condition. They can use glucose meters, insulin pumps, continuous glucose monitors, smartphone apps, and other mobile technologies to support their everyday care. However, little is known about how user experience might influence what they choose to adopt or how they choose to use technologies when practicing self-management. A series of situated exploratory qualitative studies were conducted to examine contextual factors that influence the use of self-care technology “in the wild.” Autoethnography was used to gain empathy for the everyday use of a mobile medical device and to set up a mixed method user study, involving contextual interviews, a diary study, and the observation of a diabetes technology group meet-up. A combined bottom-up thematic analysis of the data from the user studies uncovered commonalities among the users in how context influenced the use, carrying, adoption, and misuse of these devices. However, large variability in how user experience impacted self-care for the 41 participants was also revealed. Although these self-care technologies were effective, efficient, and easy to learn for the participants from a human factors engineering perspective, context specific issues arose that impacted decisions to use them. The physical environment, the social situation, the cultural context, and individual differences influence these choices. Quality of life can be impacted by the design of Type 1 Diabetes technologies, and people sometimes prioritise quality of life over immediate or long-term health benefits. This research points to the need to study the use of these mobile medical devices in-situ to understand how their design can influence adoption and use in everyday life. However, the variety of everyday self-care contexts and the diversity of possible user preferences do not lead to straightforward or universal design implications. Future work should look at the influence of design of other self-management technologies that are being developed to deal with the move of healthcare outside of clinical settings and focus on empowering adults to make personal choices about their self-care technologies that suit the context of their, sometimes messy, everyday lives