IU-Bloomington Researchers:
- Kay H. Connelly, PhD, Assistant Professor in Computer Science
University of Colorado at Boulder:
- Katie A. (Moor) Siek, PhD, Assistant Professor in Computer Science
Open University (UK)
- Yvonne Rogers, PhD, Professor in School of Informatics and School of Information Science
IUPUI Researchers:
- Josette Jones, PhD, RN, Assistant Professor at Indiana University School of Nursing and School of Informatics
- Michael A. Kraus, MD, Board certified in internal medicine and nephrology. Clinical associate professor at Indiana University School of Medicine, Department of Internal Medicine, Division of Nephrology
- Susan Perkins, PhD, Assistant professor in biostatistics at the Indiana University School of Medicine, Division of Biostatician
- Laurie L. Trevino, MS, RD, Nutrition Research Manager in Medicine, and Adjunct Lecturer in Nutrition and Dietetics, School of Allied Health Sciences
- Janet L. Welch, DNS, RN, Associate Professor at Indiana University School of Nursing
Dialysis patients can only consume 1 liter of fluid and two grams of sodium each day. Currently, patients try to remember or write down in a food diary their fluid and sodium consumption. However, these techniques are insufficient because 80% of patients are unable to restrict their fluid intake. If patients miscalculate their fluid intake they run the risk of hypertension, pulmonary edema, and death.
Our research focuses on creating a Dietary Intake Monitoring Application (DIMA) on a personal digital assistant (PDA) to assist dialysis patients accurately monitor their fluid and sodium intake. Our application will:
- allow patients with reduced cognitive skills to easily record dietary information
- allow patients to get immediate feedback on their fluid and sodium intake
- reduce the stigma of disease as a medium for recording dietary information
- assist researchers gain information about patient fluid and sodium compliance
- Act as a filter system
- Gets rid of waste products
- Balances the body's fluid content
- Produces hormones that control blood pressure
- Produces the hormone Erythropoietin to make red blood cells
- Activates vitamin D to maintain healthy bones
- Diabetes
- High blood pressure
- Glomerulonephritis (swelling of the kidneys)
- Polycystic kidney disease (cysts developing on the kidneys)
- Scarring from kidney infection in childhood
- Obstruction
Early on, patients get a fistula - an artery and vein are connected for good blood access.
End-stage renal patients use a dialysis machine three days a week for four hours each visit!
We are developing DIMA in five stages - evaluating user needs; allow users to test technology; develop the interface; create the back-end; and iteratively develop the application. In depth descriptions of each stage are below. We have completed stages 1 and 2 and are working on stages 3 and 4. Stage 5 will take place during the 2005-2006 school year.
1. Evaluate users needs and technology available
- Users may have poor eyesight (large display)
- Users may have varying computer literacy (easy to user interface)
- Doctors want to monitor user compliance (download information)
- Users may have varying literacy rates (more memory to store images)
2. Allow users to test the selected technology
- Do users feel comfortable with technology?
- Can the user press the buttons?
- How large do icons have to be for easy recognition?
- Can the user use the voice recorder?
- Can the user use the barcode scanner?
3. Develop the interface with the users in mind
- How do users record dietary information?
- How do we display a lot of information in a readable format?
- How do we convey how much fluid and sodium has been consumed?
- How can we educate patients about fluid and sodium intake?
4. Create the back-end of the application
- Transfer the UPC database to Palm database
- Integrate scanner with UPC database
- Integrate UPC database with nutritional database
- Connect back-end with interface
5. Iterative development of application
- Implement a small subset of functionality for the application
- Allow users to use the application
- Use user feedback to improve functionality and add more functionality
- Iterative development allows users to learn about the application
PDA Usability
We compared how healthy and chronically ill novice PDA users could complete conventional PDA-based tasks (e.g., pressing buttons, viewing icons, voice recording) and non-conventional tasks (i.e., scanning barcodes). All of the tasks were measured quantitatively, such as by the number of incorrect button presses, preferred icon size, or number of incorrect recordings/scannings. Thirty participants who were novice PDA users volunteered for the study: 10 healthy participants 25-30 year olds, 10 healthy participants 75-85 years old, and 10 chronically ill participants (mean age 51 years). Our first PDA usability study showed that healthy older people (75-85 years old) could physically interact with PDAs with no major differences in performance when compared to healthy younger participants (25-30 years old) [1]. Since there were no performance differences between the healthy younger and older groups, we paired the chronically ill group with the age group closest to their own for our comparisons.
We compared the chronically ill participants' success rates with our older group and found chronically ill participants were able to press buttons (T17=2.08, p=0.053), record messages (T18=1.12, p=0.279), and scan bar codes (T18=0.818, p=0.424) just as well as our group without illness. Similar to the older participants, the chronically ill participants chose large icons (18.5mm vs. 19mm) although they could read smaller icons (10.0mm vs. 8.5mm) just as well. Overall, the chronically ill participants found all of the PDA tasks easy to complete suggesting that use of technology to self-monitor dietary and fluid intake would be feasible in this patient population [2].
Paper Prototyping Study
We conducted a formative paper prototyping study to learn how one chronically ill population thinks about food, mentally organizes food, and interprets consumption-level icons. We found that many participants let their pride influence their choices, resulting in preferred interfaces that they could not accurately interpret. The results indicate that participants organized food in similar ways, had difficulty reading from their preferred consumption-level icons, and wanted to combine multiple interface designs when searching for food [3].
Barcode Education Study
We conducted a study (1) to determine how much training will be needed to use the barcode scanner for DIMA and (2) to determine when patients input the food data. During initial interviews with dialysis patients, they told us they did not eat any foods with barcodes. However, after further discussion, we found that they typically ate canned and frozen foods that do have barcodes. Thus, we have to find out the best way to teach patients about identifying and scanning barcodes.
In addition, we are interested in when people scan the food items they eat (e.g. during meals, before bed, etc.). One of the biggest problems with traditional food diaries is that patients wait until the end of the day to record their consumption. We hope by introducing an easy method of inputting food items, like scanning, patients will input what they consume throughout the day as they eat enabling real-time feedback and proactive decision support.
For this study, we developed an application where patients scan food item barcodes or voice record what foods they consume. The study was conducted in three phases: phase 1 - we met with 8 patients every other day for one week (2 people withdrew from the study); phase 2 - a three week break to review protocol and ethics reviews; and phase 3 - we met with 8 people from phase 1 every four days for a two week period. Studies were conducted during dialysis sessions to go over the voice recordings and give hints about where barcodes can be found on the food items they did not scan [4, 10, 11].
We are currently developing a customizable PDA application for dialysis patients with low literacy skills to monitor their nutritional intake [5,6]. We will test the application in April 2006.
We are working on a framework for conducting usability studies in non-traditional environments (e.g., dialysis wards) [7, 8, 9].
[1] Siek, K.A., Rogers, Y., and Connelly, K.H. (2005). Fat Finger Worries: How Older and Younger Users Physically Interact with PDAs. In the Proceedings of Interact 2005, LNCS 3585, p.267-280. (pdf)(ppt)
[2] Moor [Siek], K.A., Connelly, K.H., and Rogers, Y. (2004). A Comparative Study of Elderly, Younger, and Chronically Ill Novice PDA Users. Computer Science Department, Indiana University, June 2004, TR 595.(pdf)
[3] Siek, K.A., Connelly, K.H., and Rogers, Y. (2006) Pride and Prejudice: Learning How Chronically Ill People Think about Food. In Proceedings of CHI 2006. (pdf)
[4] Connelly, K.H., Faber, A.M., Rogers, Y., Siek, K.A., and Toscos, T. (2006) Mobile Applications that Empower People to Monitor their Personal Health. In Springer E&I. (Request Paper)
[5] Siek, K.A. and Connelly, K.H. (2005) Assistive Technologies for Dialysis Patients. Proceedings of Grace Hopper 2004 (GHC '04), October 2004. (pdf)
[6] Connelly, K.H., Siek, K.A., Rogers, Y., Jones, J., Kraus, M.A., Perkins, S., Trevino, L.L., and Welch, J.L. (2005) Designing a PDA Interface for Dialysis Patients to Monitor Diet in their Everyday Life. In the Proceedings of HCI International 2005. Paper. (pdf)
[7] Siek, K.A. and Connelly, K.H. (2006) Lessons Learned Conducting User Studies in a Dialysis Ward. In Extended Abstracts of CHI 2006: Workshops - Reality Testing. (pdf)
[8] Connelly, K.H., Siek, K.A. (Indiana University), Lafond-Favieres, V., and Bennett, G. (Georgia Institute of Technology). (2005) Planes, Pains, and Phosphorane: Usability Studies in Non-Traditional Environments. In the Adjunct Proceedings of Interact 2005. (pdf)[9] Bennett, G. (Georgia Tech), Connelly, K.H., Lindgaard, G. (Carleton University), Siek, K.A., Tsuji, B. (Carleton University). (2006) Reality Testing: HCI Challenges in Non-Traditional Environments. In the Adjunct Proceedings of CHI 2006. To Appear. (pdf)(Workshop Web Site)
[10] Siek, K.A., Connelly, K.H., and Rogers, Y., Rohwer, P., Lambert, D., and Welch J.L. (2006) The Foods We Eat: An Evaluation of Food Items Input into an Electronic Food Monitoring Application. In Extended Abstracts of UbiComp: Workshops - UbiHealth 2006. (pdf)
[11] Siek, K.A., Connelly, K.H., and Rogers, Y., Rohwer, P., Lambert, D., and Welch J.L. (2006) When do We Eat: An Evaluation of Food Items Input into an Electronic Food Monitoring Application. In Pervasive Healthcare Conference 2006. To Appear.