Design and Evaluation of an Assistive Application for Dialysis Patients

Katie A. Siek

Advisor: Kay H. Connelly

Indiana University, SURG Lab

Subject Areas: HCI, UbiHealth

Motivation & Contributions Overview of Application

Plan of Attack

Motivation & Contributions Overview of Application

Plan of Attack

Overview of Application

Plan of Attack

Motivation & Contributions

Dialysis patients must monitor their fluid and sodium intake

• 80% of patients do not restrict their dietary intake [1,2]

• 1/3 of dialysis patients cannot perform simple calculations [3]

• Paper diaries have 11% compliance rate [4]

• Electronic diaries have 94% compliance rates [5]

Current nutrition applications are not sufficient

We need… • mobile application• save intake information• varying literacy and

computation skills• varying visual acuity

accounted for

Can we create a usable application for dialysis patients?

http://myhealth.ucsd.edu/HealthTopics/kidney/kidney_relatedNews.htm

•Discussions with nurses showed patients have varying

– Literacy levels

– Computer skills

– Visual Acuity

– Dexterity

•My experiences showed patients

– Rarely used computers

– Intimidated by PDAs

– Available only during dialysis

Our first contribution…

•Discussions with nurses showed patients have varying

– Literacy levels

– Computer skills

– Visual Acuity

– Dexterity

•My experiences showed patients

– Rarely used computers

– Intimidated by PDAs

– Available only during dialysis

Design methods to integrate PDA technology

Our second contribution…

•Discussions with nurses showed patients have varying

– Literacy levels

– Computer skills

– Visual Acuity

– Dexterity

•My experiences showed patients

– Rarely used computers

– Intimidated by PDAs

– Available only during dialysis

Create a framework for conducting user studies in non-traditional environments

Our third contribution…

•Discussions with nurses showed patients have varying

– Literacy levels

– Computer skills

– Visual Acuity

– Dexterity

•My experiences showed patients

– Rarely used computers

– Intimidated by PDAs

– Available only during dialysis

Design an application that is easy to use

The importance of the contributions

• Social-Personal Issues– The digital divide is real - but people must learn to use technology

• Non-Traditional Environment Evaluation Techniques– Non-traditional environments capture the stress, limited space,

and safety, etc. that other methods do not

• Interaction Interface Design Techniques– Most research focuses on web browsing instead of interfaces for

the less experienced

Our solution is an assistive application for dialysis patients

UPC read

UPC to food

Nutritional information

updated

Dietary Intake Monitoring Application

Our solution is an assistive application for dialysis patients

Icon selected

Nutritional information

updated

Dietary Intake Monitoring Application

DIMA is being developed using a user-centered approach

• Can enter data in many ways

• Easy to carry around

• No stigma of disease

• Data and time are recorded automatically

• No calculations

• Data can be downloaded for later review

This dissertation will consist of six user studies

Study

Dissertation Goals

StatusSocial-

PersonalNon-Trad. User Study

Interaction Interface Design

Physical Interactions w/PDAs

Done

Paper Prototyping Done

Barcode Education Done

Cognitive Interactions w/PDAs

* In Progress

Familiarity w/PDA In Progress

DIMA Prototype Not Done

We tested if dialysis patients could use PDAs and scanners

Goals:

- Compare performance with conventional and unconventional tasks

- Study how the groups physically interact with devices

*Voice recording task not shown

Fat Finger Worries: How Older and Younger Users Physically Interact with PDAs. Katie A. Siek, Yvonne Rogers, and Kay H. Connelly. Interact 2005

Our results were promising

Healthy 25-30 Years Oldvs

Healthy 75-85 Years Old

Healthy 75-85 Years Oldvs

Dialysis Participants

• No difference in performance for button press and voice recording tasks

• Younger prefer 5 /10mm icons

• Older prefer 20mm icons

• Older scanned items more times, but had the same success rate

• Baracoda pen not usable

• No difference in performance for button press, voice recording, and scanning tasks

• Chronically ill prefer 18.5mm icons (older prefer 20mm)

• Both groups can read smaller icons (10mm vs. 8.5mm)

We conducted a study to evaluate mental models

Goals:

- Find out about eating habits

- Discuss attitudes towards technology

- Learn about how they think/organize food

- Test initial ideas on how to organize food and present information

Na

.5 liter of 1 L used

.1 g of 2 g used

H20

??What if

Fat Finger Worries. Katie A. Siek, Yvonne Rogers, and Kay H. Connelly. Interact 2005.

People let their pride influence their preferences

• Participants organized food similarly

• Participants preferred an interface that combined designs

• Participants were not able to read their preferred consumption-level icon

• Participants understood warnings

Pride and Prejudice. Katie A. Siek, Kay H. Connelly, and Yvonne Rogers. In Review.

A recent study focused on PDA usage and barcode education

Goals:

- Teach patients about how to scan food

- Determine when patients scan or voice record foods

- Learn if patients will carry a PDA with them (and return it)

- Discover is scanning/voice recording is a useful way to monitor intake

Our higher level results

Patient uses DIMA

Patient gives feedback

Create/modify

functionality •Design guidelines for integration and interface design

•A framework for non-traditional user study evaluation

Lessons learned…

1. Interdisciplinary research takes time

2. Tweak and resubmit (papers, grants, programs)

3. If your research area does not exist, create it yourself

(BoF or SIG Workshop Journal Conference)

Questions?

References

1. Betts, D. K., & Crotty, G. D. (1988). Response to illness and compliance of long-term hemodialysis patients. ANNA Journal, 15, 96-100.

2. Welch, J. L. (2001). Fluid management beliefs by stage of fluid adherence. Research in Nursing and Health, 24, 105-112.

3. Evans, J. D., Wagner, C. D., & Welch, J. L. (2004). Cognitive status in hemodialysis patients as a function of fluid adherence. Renal Failure, 26(5), 575-581.

4. Stone, A. A., Shiffman, S., Schwartz, J. E., Broderick, J. E., & Hufford, M. R. (2002). Patient non-compliance with paper diaries. British Medical Journal, 324(7347), 1193-1194.

5. Stone, A. A., Shiffman, S., Schwartz, J. E., Broderick, J. E., & Hufford, M. R. (2003). Patient compliance with paper and electronic diaries. Controlled Clinical Trials, 24(2), 182-199.

6. Dowell, S. A. (2005). Electronic Self Monitoring of Dietary and FluidIntake Among Adults Receiving Hemodialysis. Unpublished master's study.

Extra Slides

I created a proof prototype called Food Updater

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are needed to see this picture.

• Incorporates scanner and small UPC/Nutrient database

• Keeps track of fluid and sodium consumption

PDAs are getting lighter, faster, and have more memory

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We are creating an open source PDA nutrition database

USDA National Nutrient Database

• 6,220 Food Items

• 58 nutrients available

• 1.77 MB storage needed

SURG UPC Nutrient Database

•Website and PDA application to add and view entries

•Compare entries with USDA database and repeated entries for accuracy

We are currently looking for populations to help propagate the database

Have Have-Not

The digital divide is a real problem

Asian

56.8%

U.S. Citizen Access to the Internet in their Home (2000) [10]

Caucasian

53.9%

Hispanic

23.6%

Black

76.5% 23.5%

46.1%43.2%

76.4%

Adding technology does not solve the problem

• India’s Outdoor Kiosk [11]

• Gingrich’s laptop for every child

• Negroponte & Papert’s $100 Laptop [13]

Technology Determinism -

Assuming people will understand technology when it is introduced

Integration must be carefully planned

Integration must…

- improve education for community

- have social support

Successful Programs

- Gyandoot [11]

- Rural Healthcare PDA technology [12]

Non-traditional evaluation methods are lacking

http://www.pbs.org/wgbh/nova/bioterror/images/abou_program.jpg

Non-traditional environments (High Risk Environments) change without warning and have many constraints

We will use the Case Study approach to create a framework for evaluation

Modified RITE and IDA techniques will be used