Clinical user-experience evaluation of type 2 diabetes patients using an in-home monitoring device: complementing a telemedicine clinical trial with HCI evaluation

Jalil, Sakib (2015) Clinical user-experience evaluation of type 2 diabetes patients using an in-home monitoring device: complementing a telemedicine clinical trial with HCI evaluation. PhD thesis, James Cook University.

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A worldwide demographic shift is in progress. The percentage of the population that is ageing (those over the age of 64 years) is projected to more than double in the next four decades. People aged over 64 have a higher burden of disease, so the demand for medical care will increase. Unfortunately, the present healthcare models will be inadequate to handle the demands of the ageing population.

One proposed remedy is to provide in-home assisted healthcare with technology-intervened approaches. Telemedicine, telehealth and e-health are part of current technological approaches that provide clinical treatment through a technology intervention. These technology interventions are evaluated through clinical trials, which are common procedures in evidence based medical science.

Clinical trials are targeted to measure only improvements in medical conditions and the treatment's cost effectiveness. They do not investigate patients' experiences with these technologies. However, the effectiveness of a technology also depends on the interaction pattern between the technology and its users, especially the patients. The discipline of Human-Computer Interaction (HCI) provides various user-centred evaluation methods to assess user interaction and satisfaction with a technology.

As a component of this qualitative research study, I developed a novel research methodology - the Clinical User-Experience Evaluation (CUE). The CUE is a HCI user-evaluation technique that complements a wider medical clinical trial. This clinical trial investigated medical improvements and cost effectiveness of telemedicine in-home monitoring technology for type 2 diabetes patients in the Townsville region in Australia. The clinical trial was governed by the Townsville- Mackay Medicare Locals (TMML). The CUE investigated how patients interacted with in-home monitoring technology that was being used as part of TMML's clinical trial.

The CUE consisted of three stages: 1) a contextual inquiry, 2) a semi-structured interview and 3) an anonymous survey. I defined the precise stages of CUE to separate it from the activities of the clinical trial, which were conducted by clinical researchers/nurses. The CUE uses an ethnographic approach. I carried out the CUE in the field with nine type 2 diabetes patients. In addition, I interviewed two nurses to complement the patients' interviews.

Stage 1 of CUE was a contextual inquiry that was performed in-situ at a patient's home. Patients used the technology with the think-aloud method during this stage, during regularly scheduled times for using the technology.

Stage 2 of CUE was a semi-structured qualitative inquiry to understand patients' experience and expectations. In addition, questions that arose during stage 1 and any topic mentioned by the patients were explored. The interview took place directly after stage 1, while perceptions were still fresh in the mind of the patients.

Stage 3 was a semi-anonymous survey to encourage patients' candor. I observed certain patterns of behaviour among the patients in this clinical trial, during the first two stages. I developed a semi-anonymous survey to verify these observations by obtaining patients' opinions. This survey in stage 3 was conducted online eight months after stage 2.

Prior to the implementation of the CUE, I conducted a meta-synthesis of past clinical trials of type 2 diabetes. The meta-synthesis demonstrated that past telemedicine technologies had positive behavioural outcomes on patients. Therefore, implementation of CUE held promises of new findings in a traditional clinical trial.

Data from CUE was analysed and presented as the following topics in this thesis.

1. Patients' experience of using the device;

2. A User-Centred Design for type 2 diabetes patients;

3. Domestication of the technology; and

4. Hidden Hypotheses by patients and nurses-- this part presents my observations about the assumptions that the patients made about the trial and the assumptions that the nurses made about the patients and the technology. I call these assumptions "hidden hypotheses".

Key analytical findings from the CUE depicted that patients value the benefits of in-home monitoring but the current device did not possess all functionalities that type 2 diabetes patients require. The User-Centred Design (UCD) methodologically confirmed the functionalities the in-home monitoring device should contain, to meet the expectations of type 2 diabetes patients. Analysis on the domestication of the device showed that patients did not change the location of the device after the initial placement. The hidden hypotheses disclosed some causes of why patient feedback about technology may remain hidden in a medical clinical trial.

Item ID: 43778
Item Type: Thesis (PhD)
Keywords: clinical trials; CUE; Diabetes mellitus; health care; healthcare; home care; in-home care; monitoring; patients' experience; patients' perception; telehealth; telemedicine; treatment; type 2 diabetes; user-experience evaluation; UXA
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Publications arising from this thesis are available from the Related URLs field. The publications are:

Jalil, Sakib, Myers, Trina, and Atkinson, Ian (2015) A meta-synthesis of behavioral outcomes from telemedicine clinical trials for type 2 diabetes and the clinical user-experience evaluation (CUE). Journal of Medical Systems, 39 (3). pp. 1-21.

Jalil, Sakib, Hardy, Dianna, Myers, Trina, and Atkinson, Ian (2014) But it doesn't go with the décor: domesticating a telemedicine diabetes intervention in the home. In: Proceedings of the 26th Australian Computer-Human Interaction Conference on Designing Futures: the future of design, pp. 280-289. From: OzCHI 2014: 26th Australian Computer-Human Interaction Conference on Designing Futures, 2-5 December 2014, Sydney, NSW, Australia.

Jalil, Sakib, Myers, Trina, and Atkinson, Ian (2014) Design implications from the preliminary results of a telemedicine patient-technology interaction study. In: Proceedings of the 7th International Symposium on Visual Information Communication and Interaction, pp. 192-195. From: VINCI 2014: 7th International Symposium on Visual Information Communication and Interaction, 5-8 August 2014, Sydney, NSW, Australia.

Jalil, Sakib (2013) Persuasion for in-home technology intervened healthcare of chronic disease: case of diabetes type 2. In: Adjunct Proceedings of the 8th International Conference on Persuasive Technology, Persuasive-2013 (973). From: 8th International Conference on Persuasive Technology, Persuasive-2013, 3-5 Apr 2013, Sydney, Australia.

Date Deposited: 17 May 2016 02:19
FoR Codes: 08 INFORMATION AND COMPUTING SCIENCES > 0806 Information Systems > 080602 Computer-Human Interaction @ 100%
SEO Codes: 97 EXPANDING KNOWLEDGE > 970108 Expanding Knowledge in the Information and Computing Sciences @ 50%
97 EXPANDING KNOWLEDGE > 970111 Expanding Knowledge in the Medical and Health Sciences @ 50%
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