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Using qualitative situated methods in the design of mobile medical technologies

Key Points

  • Medical devices are increasingly used as part of patients' daily lives, so new methods are needed to ensure they are easy to use in these non-medical contexts.
  • To address this, our research has delved into understanding the real life use of Type 1 Diabetes technologies in people's everyday lives, using qualitative situated methods.
  • These methods go beyond the scope of the current human factors standards such as ISO 62366.
  • We have increased the awareness of manufacturers and diabetes charities about these methods. We are now applying them to the design and development of new Type 1 diabetes technologies, through collaborations and a new consultancy set up for the purpose.

Problem and Background
Many medical devices, such as diabetes glucose meters, are now used extensively away from clinical environments, as part of people's daily lives. Increasingly the technology itself is mobile, to be used anywhere, anytime. Appropriate methods need to be followed when they are designed and evaluated to ensure they are still safe and easy to use in these different contexts. However, existing international standards on the design of medical devices, such as ISO 62366 on the use of usability engineering in their design, do little to take this change in circumstances into account. They do not consider the context of use, and context of use has been shown to influence the use of interactive technologies. For people self-managing their health with these technologies, the influence of context on device use can impact self-care plans and potentially lead to harm.

New Methods
Drawing from the social sciences, methods exist to solve this problem though there has been little use of them to evaluate medical devices. Known as 'qualitative situated methods', they involve studying more deeply the richness of people's lives and experiences. They especially focus on the places and ways technology is actually used. Situated user experience relates to the notion that the local context is an important factor in determining how people will experience and interact with technology. These methods used to probe the actual contexts in which devices are used give ways to understand the experience of using technologies, the way they do or don't fit into people's lifestyles, the problems patients encounter and the workarounds they come up with. For example, we have explored self-study methods (where a researcher uses the technology as though they are the participant, keeping detailed notes of problems that arise), diary studies (where participants keep diaries of usage and significant events related to the technology) and contextual interviews (where a researcher observes and listens to a participant in the environment where they use the technology).

Diabetes Technologies
Type 1 Diabetes is a condition where these issues are critical. Self-management includes calculating medication doses to inject based on factors such as food consumption and current blood glucose levels using devices such as mobile blood glucose meters. Various other self-care devices commercially available including wearable insulin pumps and continuous glucose monitors, mobile apps, and other digital tools that are meant to accompany a person throughout their day, regardless of what they have planned. If people with diabetes find them impractical to use, and so fail to fit them into their lifestyles, then their condition may not be properly controlled. This could lead to harm. We have used the above methods to gain a deep understanding of how these devices are actually used in practice. We have shown that they give important understanding that would otherwise be missed. For example, they uncovered the impact that emotional experience can have on use, and the effect of different settings (such as a work meeting versus a music festival) on how the technologies are used.

Engaging with Manufacturers
We have directly engaged with manufacturers throughout the project and these relationships allowed us to press upon them the importance of understanding real world use of their devices through using methods beyond the scope of current human factors standards.

  • We were invited to talk to manufacturers about off-label unintended usage of mobile medical devices to a medical labelling conference in London.
  • At the request of Roche's new user experience group, we presented our work to their human factors team in Germany as part of a series of Usability Experience invited talks, focusing on the importance of using situated methods in the design of diabetes devices. Roche has now funded a new permanent Usability Experience position based partly on the series of invited talks.
  • We have maintained relationships with manufacturers at diabetes conferences, such as Dexcom. They have expanded their human factors group and have kept in contact with us for future collaborations, including a proposal currently being written.

Engaging with Charities
Diabetes technology charities have wanted to hear about this research. This has led to our working directly with two:

  • Tidepool, a charity developing an open source system to gather information from various diabetes devices, have been in regular contact with us and are involved in the proposal we are currently writing.
  • Input, a charity helping people with diabetes to adopt insulin pumps, has been advocating our research to manufacturers and helping us to access participants, and they assisted the proposal currently being written.

Influencing Future Diabetes Devices
We are also directly influencing the design of future diabetes technologies through collaborations with a start-up and Imperial College London:

  • Aisling Ann O'Kane, the PhD student who is the lead researcher on this project, has set up a consultancy company. Her first client is Imperial College London's Centre for Bio-Inspired Technology where she is involved in a human factors analysis using methods from her CHI+MED research. This is to evaluate a mobile artificial pancreas system before it goes to a home trial with people with Type 1 diabetes.
  • In collaboration with an Indian start-up called Diabeto, we supervised a masters student project on the acceptability of a new device and Diabeto were able to use the findings to tailor the device to UK users.

Further Reading
Furniss, D., O'Kane, A.A., Randell, R., Taneva, S., Mentis, H., and Blandford, A. (eds). Fieldwork for Healthcare: Case Studies Investigating Human Factors in Computing Systems. Morgan & Claypool Publishers, 2014.

Furniss, D., O'Kane, A.A., Randell, R., Taneva, S., Mentis, H., and Blandford, A. "HCI fieldwork in healthcare - Creating a graduate handbook," in Proceedings of the 31st ACM Conference on Human Factors in Computing Systems (ACM CHI 2013): Extended Abstracts, pp. 3203-3206, Paris, France, April 27-May 2, 2013.

Furniss, D., Randell, R., O'Kane, A.A., Taneva, S., Mentis, H., and Blandford, A. (eds.) Fieldwork for Healthcare: Guidance for Investigating Human Factors in Computing Systems. Morgan & Claypool Publishers, 2015.

Odion-Esene, F. "Exploring the Expectation and Hopes of Individuals with Type One Diabetes for New and Current Technology." Masters of Science Thesis, University College London, 2014.

O'Kane, A.A. "Beyond Medical Usability Engineering: Type 1 Diabetes Technologies and User Experience in The Wild," poster presented at the 4th Workshop for Interactive Systems in Healthcare (WISH 2013) co-located with the American Medical Informatics Association (AMIA) Annual Symposium, Washington D.C., USA, November 17, 2013.

O'Kane, A.A. "Patients' situated affective experience with mobile medical devices: Exploring the influence of context on the adoption and use of mobile medical devices used by patients," presented at the CHI+MED and the Institute of Ergonomics and Human Factors Doctoral Consortium, London, UK, June 14, 2013.

O'Kane, A.A. "Situated User Experience with Take-Home Technology Influences Adherence to Self-Management Plans for Adults with Type 1 Diabetes" e-poster to be presented at the 8th International Conference on Advanced Technologies and Treatments for Diabetes (ATTD 2015), Paris, France, February 18-21, 2015 and in the Journal of Diabetes Technology & Therapeutics (abstract only).

O'Kane, A.A. "T1 Diabetes Patients' Experience and Use of Mobile Medical Technologies," presented at the American Medical Informatics Association (AMIA) Annual Symposium Doctoral Consortium, Washington D.C., USA, November 16, 2013.

O'Kane, A.A. "Using A Third-Wave HCI Approach for Researching Mobile Medical Devices," presented paper at the Workshop HCI Research in Healthcare: Using Theory from Evidence to Practice in conjunction with the 32nd ACM Conference on Human Factors in Computing Systems (ACM CHI 2014), Toronto, Canada, April 26, 2014.

O'Kane, A.A., and Blandford, A. "Beyond Medical Usability Engineering: Exploring the Influence of Affective Experience on the Use of Type 1 Diabetes Technologies," poster presented at the 7th International Conference on Advanced Technologies and Treatments for Diabetes (ATTD 2014), Vienna, Austria, February 5-8, 2014 and in the Journal of Diabetes Technology & Therapeutics (in title only).

O'Kane, A.A., and Blandford, A. "Patients' Situated Affective Experience with Mobile Medical Devices," presented paper and poster at the Workshop on MediCHI Safer Interaction in Medical Devices in conjunction with the 31st ACM Conference on Human Factors in Computing Systems (ACM CHI 2013), Paris, France, April 28, 2013.

O'Kane, A.A., and Blandford, A. "Recruiting Diabetes Patients: a Success and a Failure," at the Workshop on HCI Fieldwork in Healthcare: Creating a Graduate Handbook in conjunction with the 31st ACM Conference on Human Factors in Computing Systems (ACM CHI 2013), Paris, France, April 27, 2013.

O'Kane, A.A., and Blandford, A. "Reflecting on Empathy during Mobile Medical Device Research," presented paper at the Workshop Enabling Empathy in Health & Care: Design Methods & Challenges in conjunction with the 32nd ACM Conference on Human Factors in Computing Systems (ACM CHI 2014), Toronto, Canada, April 27, 2014.

O'Kane, A.A. and Mentis, H.M. "Sharing Health Information in the Care of Diabetes," presented at the Workshop on Bridging Clinical and Non-Clinical Health Practices: Opportunities and Challenges in conjunction with the 30th ACM Conference on Human Factors in Computing Systems (ACM CHI 2012), Austin, USA, May 5, 2012.

O'Kane, A.A. and Mentis, H.M. "Sharing Medical Data vs. Health Knowledge in Chronic Illness Care," in Proceedings of the 30th ACM Conference on Human Factors in Computing Systems (ACM CHI 2012): Extended Abstracts, pp. 2417-2422, Austin, Texas, USA, May 5-10, 2012.

O'Kane, A.A., Mentis, H.M. and Thereska, E. "Non-Static Nature of Patient Consent Over Time: Diabetic Patients' Changing Privacy Perspectives," in Proceedings of the 16th ACM Conference on Computer Supported Cooperative Work and Social Computing (ACM CSCW 2013), pp. 553-562, San Antonio, Texas, USA, February 23-27, 2013.

O'Kane, A.A., Rogers, Y. and Blandford, A. "Concealing or Revealing Mobile Medical Devices? Designing for Onstage and Offstage Presentation" in Proceedings of the 33rd ACM Conference on Human Factors in Computing Systems (ACM CHI 2015), Seoul, South Korea, accepted for publication in April 2015.

O'Kane, A.A., Rogers, Y. and Blandford, A. "Gaining Empathy for Non-Routine Mobile Device Use Through Autoethnography" in Proceedings of the 32nd ACM Conference on Human Factors in Computing Systems (ACM CHI 2014), pp. 987-990, Toronto, Ontario, Canada, April 26 - May 1, 2014.

Sellen, K., Furniss, D., Chen, Y., Taneva, S., O'Kane, A.A., and Blandford, A. "HCI research in healthcare: using theory from evidence to practice," in Proceedings of 32nd ACM Conference on Human Factors in Computing Systems (ACM CHI 2014): Extended Abstracts, pp. 87-90, Toronto, Canada, April 26-May 1, 2014.

Vincent, C., Niezen, G., O'Kane, A.A. and Stawarz, K. "Can standards and regulations keep up with health technology?" Journal of Medical Internet Research mHealth and uHealth, vol. 3, no. 2, e64, June 2015.