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 ApplicationPlan 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? 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 Status Social- Personal Non-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 Years Old vs Healthy Years Old vs 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 H20H20 ? ? 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, Welch, J. L. (2001). Fluid management beliefs by stage of fluid adherence. Research in Nursing and Health, 24, 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), 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), 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), 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 Incorporates scanner and small UPC/Nutrient database Keeps track of fluid and sodium consumption

PDAs are getting lighter, faster, and have more memory IREthernetBluetooth802.11_ Tab Newton Palms Newton Palm V m505 Tungsten LifeDrive m505 Tungsten LifeDrive Weight (oz.) Memory (MB) * LifeDrive has 3.85G Processor Speed (MHz)

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

HaveHave-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 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