Medirio Interface by ryanhaydon

INTERFACE DESIGN INSULIN D E LIV E R Y SY ST E M Major Project report by Ryan Haydon In collaboration with Medirio & Dominic Smith

“Simple can be harder than complex: You have to work hard to get your thinking clean to make it simple. But it’s worth it in the end because once you get there, you can move mountains”

(Steve Jobs, 1998)

ACKNOWLEDGEMENTS M Y SIN CE R E ST T H A N K S Matteo De Donatis Matteo was the contact from Medirio that oversaw the project on their behalf. He provided excellent insights into the reality of the medical design market and gave his full support throughout the project. He is a great design thinker and I hope that the relationship built during this project will continue into the future. Marco Ajovalasit Marco, the project supervisor, has continuously inspired me to push further into the research and taught me a huge amount about human factors- a design approach that heavily influenced every aspect of the project. His support, guidance and continuous encouragement has progressed the project above and beyond what I thought would have been possible at the beginning. Massimo Micocci Massimo has provided his expert feedback and opinions on the device. His knowledge of the older adult market and their specific requirements has led to great insights and extremely interesting discussions. Dominic Smith Dominic's excellent work on the physical architecture of the device made making decisions on the interface simple. His excellent suggestions throughout the project helped me to explore interactions and refinement of the information architecture. All participants of user testing Particularly Colin and Beryl Fricker Colin and Beryl gave up their time whenever required to explain existing treatments or take part in experiments. Their expert contextual feedback from real patients was invaluable. Matt and Claire Haydon My parents have always encouraged me to pursue my ambitions no matter what. They taught me to always work hard and persevere towards a goal. I will be forever grateful for their love and support which has allowed me to explore my future freely.

CONTENTS REPO R T OV E R V I E W

Introduction Project introduction

Inspiration User experience analysis

8. Abstract 9. Introduction 10. Project Overview 12. Objectives 14. Deliverables 16. Time Plan 18. Background Knowledge 20. Type Diabetes 24. Market 28. Design Principles 30. Design Process 34. Usability Principles 38. Acceptance Principles 40. Proposed Principles

42. Comparative Products 44. Perceptual Map 46. Product Analysis Outline 48. Insulin Inhaler 50. Syringe 52. OmniPod 54. Pen System 56. Jet Injector 58. Contextual Interview 60. Observations 62. User Journey 64. Task Analysis (HTA) 66. Decisions (HTA) 67. User Perception 69. Decisions (Perception) 70. Information Architecture 72. Definition 74. Initial Architecture

Ideation Development & User Testing

Implementation Integration into final prototype

76. Usability Study 78. Overview 82. Prototype 01 88. Decisions 90. Architecture 02 92. Prototype 02 98. Decisions 100. Architecture 03 102. Prototype 03 108. Decisions 110. Prototype 03.2 114. Decisions 116. Final Architecture

122. Colour, Typography & Icons 124. Colour 126. Decisions 130. Typography 137. Decisions 138. Icons 140. Decisions 142. Screen Technology 143. Decisions 144. Final Implementation 146. Proposed User Journey 148. Final Prototype 156. Evaluation 158. Expert Feedback 160. Future Development 162. Conclusion 164. Back Matter 165. Appendix 178. References

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ABSTRACT PROJECT SU MMA R Y The purpose of this project was to really analyse insulin delivery systems and develop an interface for a new device that empathises with the users on a deeper, emotional level. This report formalises the work undertaken to take this idea to a solution, it includes contextual analysis of existing treatments, development of the information architecture, usability testing and final implementation. The proposed solution was design to enhance usability and social acceptance of insulin therapy, encouraging adherence to medication and encouraging good behaviour. This report details the usability principles used to aid the design process along with detailed design decisions at each stage that influenced the final implementation. The final design minimises the required interactions to perform tasks to ensure ease of use whilst offering a deeper level of understanding and tracking should the user desire it, with the information being able to be sent to the people users care about, family and doctors.

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INTRODUCTION M ED I CA L D E SI GN 'People are so concerned about being first, that they forget about being better...I believe that the world can only be saved through design... Art is to be free, design is to fix.'

(West, 2015)

The medical market is to some extent saturated with design that is concerned with being first, but not better and the Diabetes market is no different, a disease that effects 382M people worldwide and the treatment is antiquated, obtrusive and insensitive to the patients real needs and desires. This provides an opportunity to impact the market in a new, intuitive acceptable way. In collaboration with the medical company Medirio, this idea has been explored.

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OVERVIEW BRIEF The project can be summarised in one sentence: Design a user interface for an insulin delivery system. However there is a great deal more depth to the project. Medirio is a Swiss company that is re-designing the way insulin is administered, ensuring that the user has a more pleasurable experience. They are aiming to do this by reducing the stigma of insulin administration, the discreet nature of the device aids this process, being able to administer anywhere, at any time, with minimal effort.

tissue where insulin is injected. When the user requires a dose they simply select the required number of units on the hand-held device and place against the patch, they can communicate up to 5mm away from each other so the device can be used through light clothing.

Ensuring that a wide user base in terms of age and experience can successfully use the device is the most important aspect of the project and listening to their needs along with the needs of their families will provide the base of the project; allowing the creation of the underlying information architecture and hierarchy and finally all of the design decisions will be combined together to deliver a final design specification and prototype, with principles.

The device they are working on is a patch system that consists of an insulin reservoir (patch) and a hand-held device (for which the user interface is designed). The patch is stuck onto the skin and contains a small needle that pierces the skin and into the fatty

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Medirio have been working hard on the engineering behind the device ensuring the system works perfectly. However the requirements of the user and how information is represented to them is equally important. Information and interface design is an increasingly important discipline as technology increases and new users need to be targeted.

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DEFINITION OB JE CT I V E S The core aims of the project provide focus points and deliverables for the project; the first is a comprehensive usability study of existing devices, the second an outline of the information architecture both two and three dimensional elements, thirdly a wireframe showing the contents of the user interface and how they are linked, and finally the implementation of a prototype for testing and feedback from users but also to show possible investors. Usability study An analysis of five existing devices will be conducted, measuring them against six usability factors (Wilson et al. 2010a). Contextual interviews will be used to explore how real users interact with, and feel about devices, literature research to see how experts have tested and reviewed existing systems and forum based research to see how people externalise their feelings. This analysis will provide a starting point for the project showing the pitfalls of existing solutions and therefore the biggest design opportunities. Information architecture outline The structure of the system will be outlined based on the contextual research completed prior to this. The architecture consists of four components: screen size, display technology, interaction and navigation. The objective of this is to create a set of parameters to aid the design process and restrict some decisions.

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Navigation Map (wireframe) An overview of the device will be created in the form of a wireframe, a map of the entire information system, showing links and navigation between screens. The wireframe will eventually contain visuals of each screen to aid the post-design process of implementing into the final device prototype. Principles for designing for social acceptance and usability The core goals of the project translated into principles to adhere to when aiming for social acceptance, a combination of literature review, lecture theory and personal experience and observations. Prototype development. Based upon all the above elements a series of prototypes will be constructed and tested on real users to understand their needs in greater detail. This will then provide the information for the final prototype, both a “works-like” and “looks-like” to ensure the greatest detail can be outlined for future work.

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DELIVERABLES USER A N D PH Y SI CA L Mandatory

Optional

These are compulsory for the project to be successful.

Objectives that add additional elements to the project.

·· Prototype of application. ·· Looks-like specification of screen elements. ·· Thoroughly tested information architecture, reducing the number of required interactions. ·· Relevant user feedback.

·· ·· ·· ·· ··

Desirable

Enhancements

These are goals that should be achieved.

Goals that will enhance the products experience.

·· A set of design principles for designing for social acceptance and usability. ·· Intuitive IA and navigation system. ·· Intuitive interactions. ·· Usability study of existing solutions.

·· Gestural controlled elements. ·· Touch screen. ·· Encourage better behaviour.

Colour analysis. Typography analysis. Icon analysis. Dosing in under 15s. History (tracking doses). ·· Tutorial mode.

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Insulin syringes provide one of the existing therapies for patients. Image:(Ezyhealth, n.d.)

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TIME PLAN Objective Lifestyle constraints Existing Treatment research Storyboard insulin pen usage Design requirements through HTA Identify system errors Define user tasks for information architecture Intuitiveness and context research Information Architecture report Existing UI research Evaluate interactions with current dosing Research regulations, guidelines Outline sequence of actions Prototype 1.0 Explore error handling Prototype 2.0 User Testing Analyse user test feedback Prototype 3.0 Proof of UI concept Future Steps

October

November

December

January

February

March

April

BACKGROUND KNOWLEDGE

Design must fit the everyday lives of users, ensuring that they want to use it and are unashamed to administer in public, during their daily routine, perhaps commuting. Image:(Crame, 2013)

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BACKGROUND TYPE 2 D I A B E T E S Diabetes Diabetes effects 8.3% of the adult population (382M) and is set to rise dramatically to around 582M people in the next 25 years, with over $147B of expenditure in Europe alone (Federation, 2013). Type 2 diabetes (T2DM) occurs when the pancreas of sufferers does not produce enough of the hormone Insulin, which regulates the bodyâ&#x20AC;&#x2122;s ability to take glucose and use it as energy. Patients with this condition must inject a bolus dose, an injection that is specifically taken at meal times to keep the glucose level under control post-meal. This provides one of the major concerns to diabetes sufferers, the fact that they always have to think about finding a private space to inject themselves, this is due to the stigma of injecting in public, which is highly negative as the process a user must go through is met with connotations of drug use. The project overcame this through a sensitive, iterative approach grounded through human factors research. 84% of sufferers believe that T2DM is stigmatised by others (Browne et al. 2013). There has been a large amount of publicity stating that obesity causes T2DM, which it can. However this has led to a great number of non-sufferers assuming it is caused by a patients lifestyle, that they are lazy and have let this happen to themselves (Hilson 2014). This can lead to people with the disease feeling that they are negatively stereotyped and therefore have inadequate opportunities, which people have expressed as more prominent than explicit discrimination. For example â&#x20AC;&#x153;I looked up the adoption [criteria]...a couple of the

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countries said ‘no type 1 or type 2 diabetes’...I suppose if adoption agencies are saying no diabetes then that’s not going to happen. (#16, woman, 35 years)” (Browne et al. 2013, p.6). Therefore, some patients can feel the need to hide their illness.

a positive behavioural change, healthcare professionals have actually had a detrimental effect to patient progress by focusing on the negative aspects of a patients behaviour. It is not experienced by all patients, however those that do feel effected become cautious of further professionals and may end up not seeking any further medical help and rely on internet sources. (Browne et al. 2013).

There are three main sources of stigma, these are: Media: There are two sides to the media’s current approach of T2DM being a lifestyle disease; firstly it continues negative stereotypes from the community and creates unpleasant emotional reactions within sufferers of the disease. However on the other hand, the disease does contain a lifestyle aspect and reinforcing this encourages patients to lead more active lives and also creates a helpful and responsible preventative message. Furthermore the disease has association with premature death and substantial burden on the patients, the health system and society as a whole.

Family and friends: In general, the family and friends of sufferers can provide invaluable support during tough times living with the disease. However a large majority do describe events where negative comments behaviour has left them feeling hurt, particularly when in reference to dietary choices as they always feel the pressure to eat well.(Browne et al. 2013). These stigmas can lead to people mismanage their medication and one of the key points regarding every insulin delivery system is the requirement for self-management. All devices require the patient to be educated in the consequences and invested into the treatment for it to be successful and to avoid

Healthcare Professionals: Some patients have reported that rather than providing support and encouragement to promote

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non-adherence. Patients have described a general resistance to taking medicines and none want to take more medicine than they already are (Elliot et al. 2001 p.3). In the United States alone it has been documented that up to 50% of people are not taking medication as recommended which incurs costs to the healthcare system of an estimated $300 billion (Foo et al. 2011 p.1). The main reason for non-adherence in patients, especially older adults is forgetfulness, with around 24% of patients reporting this as the leading cause (Boston Consulting Group 2003 p.1). The non-adherence to medication then exacerbates the existing conditions of the illness. Many devices now provide audio or visual cues to remind patient on medication times. There is however a challenge related to all of these devices, it is that of long-term adherence which deteriorates over time and is increased in patients with chronic illnesses. Whilst all the advances in devices focusing on simplifying medication delivery are positive, a multifaceted approach is now needed for behaviour to be sustained in the long term

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(Sabate, World Health Organization 2003 pp.107-114). There are a number of factors that patients (with more than 1 illness) take into consideration when deciding to take / not take a particular medicine, these are: symptom control, side effects, fear of the disease, cost, negative experience, beliefs and acceptability (administration route and stigma). Whilst not always explicitly a yes or no to a particular drug these influence how a patient views different treatments (Elliot et al. 2001 p.3). The main factors that are experienced when the patient has a single illness are reduced to the side effects, cost and acceptability. Many health conditions and particularly T2DM can be improved dramatically through simple lifestyle modifications such as; increased exercise and the weight loss that comes with it, a tailored nutrition plan and ceasing smoking. It has been shown that when choosing between medicine and a lifestyle modification, people are increasingly likely to pick a modification because of side effect concerns or a dislike for taking the medication (Elliot et al. 2001 p.4).

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DIABETES MA R K E T Target Market The T2DM market encompasses around 92.5% of the total number of cases worldwide, which is equal to 353 million sufferers (Centers for Disease Control and Prevention, 2014). Of these sufferers, the large majority, especially in Europe use a pen injector system. This leads to an expenditure of around $136B. (Federation, 2013). Furthermore the complications involved with the disease mean that around 28% of deaths in patients are related directly to the disease.

appropriate ways to ensure the experience for older adults is as easy as possible. These include, using intuitive gestures, ensuring button function is unambiguous and minimising navigation to 3 clicks in any direction. (Wilson et al. 2010a) Many older adults are experiencing multiple health concerns and having a high blood glucose level puts you at risk of a variety of other conditions including, heart attacks, strokes and kidney problems (HealthinAging.org 2012) all of which are more common as people age. These factors mean that many older adults with diabetes have a complex regime comprising of multiple tablets/ injections on different days and at different times. It is also suggested, that as people experience an increasing number or medical conditions, their adherence to therapies/regimes decreases (Chiou et al. 2014), providing an additional barrier to improving or maintaining quality of life.

Many of these complications relate to the fact that a large proportion of sufferers are older adults, with around 40% of cases found in people over the age of 65 (Kirkman et al. 2012). Designing with this age bracket in mind provides two key areas of focus: Many older adults are less technologically aware, therefore the time taken to become proficient on a device of sufficient complexity, is much greater than that of a young adult. There are

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Insulin Delivery The insulin delivery system market for T2DM is largely saturated with very similar, conventional injector pens. The user defines the dose they require through rotation of a dial on the opposite end from the needle, removes the cap and injects into the skin, usually around the torso. The maximum dose of these devices range from 40-80 units (1 unit is 1/100th ml) in 0.5-2.0 unit increments (Graveling & McIntyre 2008). There are other devices that can be used in a similar way to insulin pens; syringes which are cheap and disposable, and specialised large dial devices for patients with visual impairment. However these are very rarely used as they provide obvious drawbacks from regular insulin pens. Familiarity is a key point when designing a piece of technology that radically changes the user experience from that of itâ&#x20AC;&#x2122;s preceding. There are a number of touch-points to consider when approaching insulin delivery systems. The first is the user's journey through dosing and administration, the key point here being the tactile experience of dosing, turning a dial is a point of familiarity that may make the transition from a pen device easier and more intuitive. The second is the feedback that is experienced when injecting, the user must press and hold the button for 10s to ensure successful administration, a feature that will feel natural upon moving to a new device. Both of the features can help to create a harmonious transition into the new technology. Healthcare technologies and interfaces have to combat an interesting problem, that of trust. A product must have a certain aesthetic, form and signifiers that leave no doubt in the userâ&#x20AC;&#x2122;s mind as to the purpose of the device. The user therefore has trust that device X will get rid of or aid symptom Y, there is however a reverse side to the trust coin, which is that for people unfamiliar with the user, it provides an immediate feeling of discomfort and illness. Furthermore people that have diabetes are often extremely uncomfortable revealing this to people because of the stigma surrounding the disease (Lin et al. 2008).

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North America

South America

46%

Undiagnosed

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Europe

Middle East & North Africa South East Asia Western Pacific

Africa

Diabetes cases by prevalence throughout the world. (International Diabetes Federation, 2013)

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DESIGN PRINCIPLES

A set of principles for designing for social acceptance and usability outlined to base further design decisions. Image:(Startup Stock Photos, n.d.)

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DESIGN PROCESS HUM A N -CE N T R E D IDEO HCD The design process starts with the breakdown of Human-Centred Design (HCD) and IDEOâ&#x20AC;&#x2122;s toolkit. HCD is a process that is used to create new products, interfaces and services, it is titled humancentred as it starts with the people. It allows the breakdown of users needs, dreams and behaviours to learn how to appropriately affect their behaviour. The process starts with three questions what is desirable, feasible and viable. (IDEO, 2011) Desirable What do people desire ? Feasible What is technically and organisationally feasible ? Viable What is financially viable ?

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Start Here

DESIRABILITY

FEASIBILITY

VIABILITY

All designs that use a human centred process should hit the centre of this diagram, being desirable, feasible and viable

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(IDEO, 2011)

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H Hear

C Create

THEMES

Time STORIES

OBSERVATIONS INSPIRATION

IDEATION

Process The process is split into three distinct areas Hear (Inspiration), Create (Ideation) & Deliver (Implementation), the journey flows between concrete observations and abstract ideas/insights before a final implementation plan can be defined (IDEO, 2011). Hear (Inspiration) Collection of data and inspiration through user research. Create (Ideation) Translation of research into opportunities, solutions and prototypes. Deliver (Implementation) Realisation of solution including an implementation plan. _ 32 _

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D Deliver Abstract

OPPORTUNITIES

SOLUTIONS PROTOTYPES

Concrete PLAN IMPLEMENTATION (IDEO, 2011)

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PRINCIPLE 01 U SA B ILIT Y The definition of usability in the ISO 9241 standard is: “The extent to which a product can be used by specified users to achieve specified goals with effectiveness, efficiency, and satisfaction in a specified context of use” In Designing Pleasurable Products, Pat Jordan describes usability as “vital but not the whole story” going on to say: “Although usable products will not necessarily be pleasurable, products that are not usable are unlikely to be pleasurable. Usability then, should be seen, in many cases as a key component of pleasurability” These two views on usability approach the subject from two different, equally valid positions. The ISO standard stating very quantifiable goals or targets that can be measured to achieve a usable product, interface or product. Pat Jordan on the other hand explores a deeper emotional connection to pleasurability, no matter how many of the usability targets a product hits, if it is not pleasurable for the user, it won’t be used. He furthers the exploration of pleasure by defining “the four pleasures” as a framework to facilitate moving human factors beyond usability. These are categorised into: Physio-pleasure Pleasures connected to the human senses, touch, taste, smell etc. in the context of products this is mostly concerned with tactile (holding and touching during interaction) and olfactory (smell and pleasure) properties. (Jordan, 2000)

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Macintosh is widely regarded as bringing usability to the personal computer market in the 1980â&#x20AC;&#x2122;s

Image:(Fager, 2010)

Socio-pleasure

Defined generally as the pleasure experienced when in the company of others. This includes person-to-person relationships as well as personto-society relationships and the way status, image and stigma effect these. (Jordan, 2000) Psycho-pleasure Concerns peoples cognitive and emotional reaction to a product or system. With regards to cognitive demand, the errors experienced when performing a task and emotional pleasure of completing the task. (Jordan, 2000) Ideo-pleasure Discussing very theoretical entities Ideo-pleasure looks at the emotional connection to the user through their beliefs, for example a product made from biodegradable materials could, to some users provide additional value. Similarly the aesthetics of a product or system can provide added pleasure over itâ&#x20AC;&#x2122;s functional benefits. (Jordan, 2000)

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Further from the ISO definition of usability there are six key factors that can be used to measure the success of an interfaceâ&#x20AC;&#x2122;s usability. Whether it is a 2D or 3D interface the principles provide a marking criteria for the system as a whole (Wilson et al. 2010a) and the following are the most relevant to medical, application based devices and interfaces. Learnability

Memorability

This measures how easy a system is to learn upon first use. It is measured primarily by analysing task performance for a user or users who have had very little experience to the task and interface, therefore people who are unfamiliar with insulin delivery will work well when measuring this.

Tracks how easy the system is to become familiar with, after a period of inactivity. Although unlikely in the given system as users should be administering every day it is important to ensure that the memorability of the interface is high.

Efficiency

Comprised of two components; firstly the ability for users to make a mistake when using the device, perhaps pressing an incorrect button or becoming confused. Secondly the management of errors in the device itself, low battery warning and failed dose being prime examples of this.

Errors

Extremely similar to learnability but involving a user who is familiar with the system, it is often improved by reducing the number of clicks or interactions to get to a particular end goal. However ensuring that the information cluster (density of possible interactions) is low is important to keep the data easy to parse.

Satisfaction Combines a great deal of the information from the above factors, but importantly it includes personal opinions and feelings about the device, how is it perceived by the user. These feelings are hard to measure but exercises can be conducted to probe people about this. Using a relating task, asking the user to give the device a personality and building a persona is useful to see how they see the device.

Effectiveness Arguably the most important and fundamental component to usability. It outlines the extent to which the system goals are achieved, which in this case is to successfully administer a dose of insulin. If the user cannot do this, the interface has failed.

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Interface should be usable quickly and easily on-the-go. Image:(Essl, n.d.)

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PRINCIPLE 02 SOCIAL A CCE PTA N CE User Perception

user with information about the product and context. Therefore it needs to be considered thoroughly with regards to social acceptance.

It was interesting to note through research that users often did not know explicitly the opinions of strangers in regards to diabetes, the treatment and stigma attached. It was largely thought that strangers held negative connotations towards the disease but nobody was able to say this with any certainty. This suggests that encouraging users to believe that the device is acceptable to use in public is the largest challenge when overcoming social acceptance

Challenge Flow is an aspect of psychology that looks at the â&#x20AC;&#x153;completely focused motivationâ&#x20AC;? that a user can experience when completely absorbed in a given task. It can be applied to the social acceptance of a product, because ensuring that the user is motivated to use the device, despite any restrictions is the first step towards ensuring acceptance (Rico and Brewster, 2010). Csikszentmihalyi outlines challenge as being one of the key aspects to ensure that users feel motivated to use a product with the system being adequately challenging (interesting) to capture their attention.

Emotion In the book, Emotional Design, Don Norman discusses the thought that the emotional side of design may be more critical to a productâ&#x20AC;&#x2122;s success than its practical elements, and to a large extent emotion is the largest factor effecting the social acceptance of a product or interface. The stigma faced by a product is largely controlled by peoples' emotional responses, with users taking pride in their belongings because they bring meaning into their lives (Norman, 2005). Without the emotion the user would not be able to make appropriate decisions, emotions pass judgements presenting the

Desirable Acceptability of the device can assured by creating a desirability factor with the public being interested in the device rather than sceptical of the function and the users' health. Having impressive aesthetics on the interface ensures desirable. The product must also be considered in relation to it's context.

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Usable in social, everyday situations Image:(Sheldon, n.d.)

Confidence

A commonly held expectation of what will happen when a button is pushed in a particular context is a useful tool for design. Taking advantage of such expectations will help users to learn the device, and ensure its function is memorable so that the user becomes confident at performing required tasks. Items should also be configured to ensure the necessary interaction evident for the user (MacLeod 2004, p.28).

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PROPOSED PRINCIPLES SO CIAL ACCEPTA N CE & U SA B I LIT Y Ensure the product is pleasurable Ensure the product is desirable Ensure the product has as few interactions as necessary Ensure the product is challenging Ensure the product contains no redundant information Ensure the product gives useful feedback Ensure the product handles errors appropriately Ensure the product evokes confidence

For more information please see supplementary principles booklet.

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Leave the user feeling good Image:(Pandone, n.d.)

COMPARATIVE PRODUCTS

Insulin administration products analysed as a basis for further design decisions.

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PERCEPTUAL MAP

INSULI N T R E AT ME N T S There are currently seven distinct insulin delivery systems, these have been mapped onto a diagram showing the perception of the product, the vertical scale showing acceptance and the horizontal showing usability, the size of the circle represents the cost of the treatment. From this, the following five were chosen for deeper analysis against usability factors.

1. Insulin Inhaler

5. Jet Injector

Selected for analysis as it provides an interesting alternative to needles that are not user friendly.

Analysing the pitfalls of the most unusable system.

2. Syringes

Not chosen as they are primarily an accessory to injector pens.

6. Injection aids

Chosen as to understand the pitfalls of the most unacceptable device on the market

7. Patch Implant Not chosen as the devices are not really on the market yet, most still in testing, with the available ones being extremely expensive.

3. Pump system (OmniPod) Selected for analysis as the OmniPod pump provides the closest competitor for the Medirio device. 4. Pen System The most commonly used therapy, chosen as to analyse features and aid migration to Medirio device.

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High acceptance

Low Usability

High Usability

Low acceptance

Selected for analysis

Low Cost

Not selected

Higher Cost

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ANALYSIS OU T LIN E feel natural upon moving to a new device. To further understand the nuances of different systems and how these effect the design of a new insulin delivery system a comparative product analysis was conducted. The main competitor product for the device is another patch system called Omni Pod. It was analysed along with the main other delivery systems available in the UK market. The devices provide a radically different administration experience but are compared to outline downfalls in their usability and inform future design decisions. Areas are scored 1-10 (with 10 being the best).

Familiarity is a key factor when designing a piece of technology that radically changes the user experience from that of the preceding treatment. There are a number of familiar aspects to consider when approaching insulin delivery systems. The first is the userâ&#x20AC;&#x2122;s journey through dosing and administration, the key point here being the tactile experience of dosing, turning a dial is a point of familiarity that may make the transition from pen device easier and more intuitive. The second is the feedback that is experienced when injecting, the user must press and hold the button for 10s to ensure successful administration, a feature that will

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ive

ne ss

Sa tis

fa c

fic Ef

tio

Learnability

Memorability

Insulin Inhaler

Syringe

OmniPod

Pen System

Jet Injector

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INSULIN INHALER EXPENSI V E H I GH T E CH Insulin Inhalers provide one of the best alternatives to needle baring devices as the device is easy to understand, working very similarly to and appearing inconceivably different to a conventional inhaler, therefore it scores consistently across the four initial categories. Itâ&#x20AC;&#x2122;s performance drops in the last two due to itâ&#x20AC;&#x2122;s lack of feedback and price point compared to most other devices on the market.

(Exubera, n.d.) _ 48 _

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Learnability

Memorability

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SYRINGE LOW COST, D ISPOSA B LE Being the most simple device on the market at the moment, learnability, efficiency and memorability score full marks. The major downfalls of syringes however, are that they struggle to provide 100% accurate dosing, and crucially it has extremely negative connotations of drug use when viewed by strangers, ensuring that users are less likely to provide adequate care to themselves. The primitive technology means that the error handling and satisfaction scores are exceedingly low.

(Radio Kerry, n.d.) _ 50 _

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Learnability

Memorability

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OMNIPOD PATCH SIM I LA R SY ST E M The OmniPod patch provides an interesting comparison to the Medirio patch device. It provides great effectiveness and is a great deal more discreet than many other systems, so scores well in satisfaction. It is let down by itâ&#x20AC;&#x2122;s ease of use, due to the confusing information architecture and requirement for instruction on how to use. Instructions and tutorials are a highly important aspect of the device, as ensuring first time users can pick up and successfully dose is crucial. The language must be carefully chosen and displayed in an appropriate manner to ensure easy understanding.

(OmniPod, n.d.) _ 52 _

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Learnability

Memorability

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PEN SYSTEM M OST POPU LA R Learnability, efficiency, effectiveness and memorability score highly due to the systems simple design, the usability is let down by little or no error feedback and a device that has limited capabilities. It is however, the most popular insulin delivery system with around 90% of European users choosing to dose themselves in this way ((Centers for Disease Control and Prevention, 2014)

(Roshdy Pharmacies, n.d.) _ 54 _

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Learnability

Memorability

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JET INJECTOR NEE D LE -LE SS Jet injectors score extremely poorly because, whilst they are used in the same way as a conventional pen system the device lacks accuracy and the patient may not be receiving the amount of insulin they require. This is very dangerous and can lead to serious health complications. There is no error feedback to assist with this and the patient may only know when they test their blood sugar or if they start to feel low. This treatment is reserved for people with an extreme phobia of needles. Another drawback to the device is itâ&#x20AC;&#x2122;s appearance, it is a very strange, tool like machine that looks very aggressive.

(Injex, n.d.) _ 56 _

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r Er

ive ne ss

Sa tis

fic

Learnability

Memorability

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CONTEXTUAL INTERVIEW

A contextual interview undertaken with a diabetic patient and insulin pen user to further understand the

administration

process and effects on lifestyle.

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INTERVIEW OBS E R VAT I ON S To understand more about the workings of the pen system and it’s user journey a contextual interview was undertaken. An hour was spent with diabetic patient of 23 years Colin Fricker. Having used a pen system almost his entire diabetic life he is well versed in the process, it’s benefits and it’s limitations. In order not to bias his views or comments on existing therapies Colin was not informed of the idea behind the device. Likert scale type questions were used to give context to each situation, encouraging him to elaborate and think.

Immediately after being diagnosed I really remember worrying about what I would do if I went out to eat with friends or family. However in the first couple of years the toughest aspect was getting used to testing blood sugar and injecting myself daily, I was a little squeamish and the thought of having to inject myself three times a day made my stomach turn. What do you think is the hardest thing about living with the condition now ? Surprisingly it is not any of the health concerns as I am very careful with what I eat, although they are becoming more prominent the older I get. The hardest thing is the injecting, especially if I am out. I am always planning where my next injection will be, often searching for public toilets if I am out, it’s not that I am embarrassed to inject in front of people, it’s just that I don’t want them thinking I am taking something funny or look at me like I’m ill. People shouldn’t think of me like that.

You have obviously had a great deal of time to come to terms with the condition and it’s effect on your life. How would you say it has changed your life ? I don’t know how much I do differently now because it was so long ago that I was diagnosed. I know that it was a big factor in helping me to quit smoking and I really appreciate that. At first it restricted me from eating what I wanted as I used to eat a lot of sugary food, I have a bit of a sweet tooth. However after a while I got used to the change in diet and even slimmed down quite a bit!

Do you think there is a ‘best thing’ about living with the disease? And if so, what ? That’s tough because I guess that although it is a disease it has in a way had some positive impacts on my life however they often come with negative aspects too. If I had to pick one it would be

Initially, in the first couple of years what was the hardest thing about living with diabetes ?

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the improvement of my lifestyle. Stopping me smoking and improving my diet, however I do miss some of those things though.

Have you ever mismanaged your medication? If so, was it a conscious decision and why?

You use a pen system, what are your overall opinions of the therapy ? Anything you would like to change ? Or anything you think is done particularly well ?

Of course I have forgotten to inject myself, but I can’t remember a time where I have stopped the medication on purpose. Some people suggest that they feel stigmatised by the public, healthcare professionals and friends/family. What are your thoughts on this?

The insulin pen system works pretty well for me, it is portable without being too small and increasing the chances of me forgetting or losing it. I would like it to be a bit more inconspicuous and look less like a medical device. I would also like it to hurt less when I inject, sometimes it’s really painful.

Similarly to the question about strangers I guess I don’t really know what the general public think although there is often a question of how my lifestyle effects my health, perhaps insinuating I was or am unhealthy. As for doctors, some seem to nag rather than encourage, I do see a specialist who is a lot better at dealing with the problems faced by diabetics. My family and friends are very understanding of the condition, perhaps this says more about them than how the overall population feel.

What do strangers think of the insulin pen? I’m not too sure what they honestly think, I guess I only know what I think they think if that makes sense. I think they think it’s really negative, that I’m really ill and some people are a bit wary of the needle. I haven’t ever just injected in public to see what people actually think, I guess I don’t have the confidence. _ 61 _

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USER JOURNEY INSULIN A D MI N IST R AT ION This user journey maps the timeline of administering insulin, against the user satisfaction of performing the given sub-task. The satisfaction is shown on the vertical axis and whilst there is no value assigned, it is the relationship between each point in the timeline that is of importance.

Initial drop in satisfaction as the user is reminded what they have to do.

Remember to inject

Pressure and apprehension of finding a discreet location to inject.

Measure blood sugar

Work out dose required

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Find location to inject

Check insulin level

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The monotony of having to replace the cartridge and either waste insulin or inject twice.

Replace Cartridge

Select dose

Sharp pain sometimes experienced when injecting decreases satisfaction dramatically.

Pierce skin

(Optional)

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Putting the device away and not having to inject gives the user the greatest increase in satisfaction.

Hold inject button

Pack away pen

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TASK ANALYSIS Interview questions provide a good initial source of information but answers can often have a hint of bias. To further understand the injecting/dosing/priming process and understand whether what Colin was saying reflected his actual feelings, he was asked to outline the process of using his pen broken down to as many steps as possible. From this a Hierarchical Task Analysis (HTA) was compiled which, along with SHERPA

No.

Task

Required Knowledge

1.0

Calculate Dose

1.2

Forecast dose requirement

2.0

Check Pen

2.1

Check insulin level

The required dose

2.3

Remove needle guards

N/A

3.0

Replace Insulin

4.0

Prime Pen

4.1

Shake Pen

Crystallisation of insulin

4.2

Turn dose to two units

N/A

4.3

Air Shot

Check needle is expelling insulin

5.0

Administer injection

5.1

Turn to required dose

Required dose

5.2

Bunch skin on injection site

N/A

5.3

Insert needle

Depth to push needle too

5.4

Push plunger

N/A

5.5

Leave for 10s

Insulin dispersion

6.0

Needle Disposal

Food to be eaten & glucose level

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(Systematic Human Error Reduction & Prediction Analysis) has outlined the particular pitfalls of insulin pen therapy and allowed for decisions to be made to prevent these. These have been combined in the below table which shows the most important and relevant tasks, errors and the solutions available (full table available in Appendix 01). The rows highlighted in green were to be implemented into the device as a high priority.

Feedback

Potential Problems

Solutions

N/A

Inaccurate dose

Monitor average dosing

Visual representation

Throwing away insulin

Inject remaining insulin ●

Tactile vibrations

Injury whilst removing

Remove needle interaction

Liquid hitting phial

Cartridge/needle clogged

Appropriate error message ●

Jog wheel (dial)

Selected dose too large

Pushing motion of pen

Needle clogged

Appropriate error message ●

Jog wheel (dial)

Selected dose too large

N/A

Inappropriate area inject in

Allow change of dose size ●

N/A

Needle not in far enough

Click through values

Pushed too hard

None

Not left for long enough

Allow change of dose size ●

Education of locations Keep needle inside user Inject button force tangential to needle direction

Feedback to show time lapsed

Implement into device _ 65 _

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DESIGN DECISIONS TASK A N A LY SIS Monitor average dosing It is likely that the user would dose similar amounts at different times during the day. Having a breakfast dose, lunchtime dose and dinner time dose, the device could spend the first month tracking these and then continue to average the doses as they are administered. Inject remaining insulin Upon dosing there could be a situation whereby the user has selected a dose with insufficient insulin in the device. In the insulin pen system, the user would have two choices: 1. Inject twice, first the remaining insulin then a top up with new cartridge. However many users do not like to inject twice 2. Throw away the cartridge with whatever is left inside it, wasting insulin. The new system will recognise this and will finish the insulin remaining in the patch, then prompt the user to top-up the required amount. Appropriate error messages Error response is extremely important when ensuring the system is usable. The pen is an analogue device and as such has no error explanations. The new device gives the user solutions to any errors without telling them what has malfunctioned, as this data is redundant to the user. Allow change of dose size Some pens do not allow a reduction in the dose size without releasing some insulin from the needle, allowing the user to go backwards and forwards when selecting a dose is a very important function.

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USER PERCEPTION THOUGH T S A N D D E SIR E S The last exercise undertaken with the participant tries to further assess the thoughts of the user, and is based on the work of Marieke Sonneveld, using a set of questions to discover information about users perception that were previously unmeasurable. The exercise was designed to investigate tactile experience, but it is an extremely useful way to make the user think. It starts with a simple question:

What do you mean by “looks very functional”? I guess the fact it’s brown, a strange clean brown and green, these feel like hospital colours and the shape looks purposeful. You mentioned purposeful, if you had to assign the pen personality traits or jobs based on it’s properties what would they be ? For example a fineliner could be described as a butler, functional, smart and professional.

How do you interact with the product [insulin pen]? Pretty much 100% of the time I am using it when I am injecting so don’t really do anything else with it, I do like the clicking of theuy8 end when I turn it, the sound and the feel.

Doctor seems quite obvious, it’s quite nagging, boring also comes to mind. Perhaps a doctor that moonlights as a librarian. How do you feel when interacting with the pen ?

What properties of the pen are important for you to accomplish your goal ?

I feel a sense of relief, control of the condition, I also concentrate a lot in an “I don’t want to mess this up” sort of way. Concern over whether the injection will hurt.

It’s strong, I feel like I can trust it, the fact that it looks very functional also makes me feel trust.

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Apprehension ? Yes, apprehension works, along with self-consciousness Now, how would you like to feel when interacting with insulin delivery? Relaxed, at least less concerned than I do now. Thatâ&#x20AC;&#x2122;s the main change I would say, obviously I still need to concentrate, perhaps it could be more enjoyable though. Positivity would be good too. OK, so what personality traits does the new system need to have to make you feel this way? Professional, smart, fun, light heartedness. Can you think of any objects that communicate these messages ? I think a good suit.

_ 68 _

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DESIGN DECISIONS USER PE R CE PT I ON Apprehension Currently users feel some apprehension when using the device, especially in public situations. Applying principles for designing for social acceptance will greatly improve these feelings of the user. Relaxation Relaxation in context of the situation is the absence of anything emotionally overwhelming or redundant in the system, ensuring that the information design of the system is simple, intuitive and clear. Trust Mentioned by the participant in the interview along with secondary research trust ensures the user believes the device is of benefit to them, the initial information architecture reflects this.

_ 69 _

INFORMATION ARCHITECTURE

The organisation and overview of version one of the information architecture. Mock-up: (Pixeden, 2015)

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INFORMATION ARCHITECTURE D E FIN E D Information Architecture (IA) is the theory behind organisation of typically digital screen based systems. It encompasses a range of ideas: presenting, searching, browsing, labelling, categorising, sorting and even hiding information (Tidwell, 2011, p. 25). Having a structured, simple IA can shape a product and enhance its usability (Morville, 2006). Components There are four main components and techniques that capture the concept in an IA (Crawford, no date). These are outlined by Louis Rosenfeld and Peter Morville in the book Information architecture for the World Wide Web (2002), they are: Organisation systems are the categories in which information is placed, for example dose size, history and user information. They play an important part in differentiating pages or sections in the application. Labelling systems look at the terminology used through the system, taking into account the user's experience with the system. For example, the system should use "Insulin medication" rather than "Medicament" as it is more familiar to the user. Navigation systems are the way the user moves from one piece of information to the next, can be simple next/back buttons or more complex, gestural navigation. Searching systems are a requirement for most applications as at some point the user is going to want to search for some piece of information, here it is likely a previous dose, presented as a dated list or calendar.

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Organisation

Navigation

Dosing, selecting and injecting Priming, new patch information History, previous doses User Information Device Information

Scroll wheel, intuitive up/down, left/right movements Back/next buttons Simple swipe gestures as to not intimidate users.

Labelling

Searching

Basic language that is not intimidating to new inexperienced users. Medicine over medicament Insulin Units over mg (milligram) Error instructions to give the user instruction on what do to rather than diagnosis of what went wrong.

Dose represented as an on screen variable data point. History represented as a calendar as to aid the understanding of time and underlying patterns that may occur.

First sketch of IA organisation titles

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Initial Information Architecture The embodiment of secondary research and usability studies the initial IA shows a four page design that has multiple crossing points where one page can navigate to another, it is good practice to minimise these interactions that can clog the systems flow. This outline was used as a basis for the initial prototype to allow for testing with users.

Information architecture V1

USABILITY STUDY

Initial prototype testing

Cardboard button mock-up testing

Prototype v2 testing

Final prototype testing

I DE AT IO N

USABILITY STUDY OV E R V IE W Usability testing is the process by which products and interfaces can be tested. Representative users (participants) will be set typical tasks, while an observer or facilitator watches, guides and takes notes. The outcome is to collect both quantitative and qualitative data and to analyse any usability problems. Satisfaction can also be measured during these tests.

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ID EA TI ON

Essential Metrics When testing the usability of an interface it is important that there is clear knowledge of what needs to be measured. The following metrics (Sauro, 2011a) can outline certain aspects of the device from overall success of the device to more qualitative satisfaction levels. They can also be combined to give a deeper understanding of usability. Completion Rates

difficult tasks rather than satisfactory ones as the bad memory is more likely to be remembered. Errors: Processed through observations of the test, any time the user performs an unintended action or mistake it is noted. These can be collated across all users and given severity ratings which can then be mapped to interface issues.

Typically measured with a 1 or 0 value to record a success (1) or failure (0) of a given task. Often regarded as the fundamental metric of usability as it shows the ability of a user to accomplish a goal. Usability Problems Problems encountered during the test, rated by severity and how many users experienced it. This is then used to work out the probability of experiencing particular problems and which are found by only single users.

Expectation

The best measure of efficiency, especially when analysing a given branch of the interface. The time is started when the user has finished being briefed on the task and ended when the task is completed. Is useful when combined with Click Count (no.7) to greater measure efficiency.

Whether users like it or not, they will always have an expectation of a task and how difficult they expect it to be. Questioning this prior to the task being attempted provides a measure to compare actual difficulty ratings to. Click Count: Users may not always use the shortest number of clicks to get to a specific place in the application. As the click count increases it is likely that the clarity of information decreases as the user is confused what to interact with.

Satisfaction

Single Usability Metric

After a task or test has been attempted, the user is asked a series of questions to describe the difficulty of the task. This technique is better at outlining

A standardised average combining completion rates, satisfaction and task time to provide a more indepth measure of effectiveness, efficiency and satisfaction.

Task Time

_ 79 _

I DE AT IO N

How many users will be tested? At each round, four users were tested; there are a number of reasons for this. Firstly the initial three users are likely to highlight the same, most significant problems. Secondly, the reduced number allows for more rounds of testing as the testing phase does not take too long. Finally it allows for testing and debrief in the same day, allowing focus on the main problems and how to fix them (Krug,2005). Who will be tested? Both diabetics and non-diabetics alike, it was more important to test regularly (once a month) and use a group of people who provide a wide view of the abilities of potential users; than spending time organising with official organisations to try and test once, a group of diabetics. The non-diabetics also have no experience with insulin delivery, allowing the analysis of the learnability factor. Two diabetic users will be tested in each round of testing whilst the other two participants will be unfamiliar with the device. Where will the tests take place? All rounds of testing apart from the final took place in the users home, a place where they can relax and feel comfortable talking about and experiencing the device. The final tests were held in a number of different scenarios in which the user may have to administer, at a friends, in a coffee shop or in a shopping centre. This provided extra context to the results and a mock-up of the system will be used. What will be tested? Each round of testing involved specific tasks and objectives which are outlined in the individual testing sections. Each time the participants were asked to dose an amount of insulin. The participant can dose any amount they like, this simple choice helps to gain more accurate results as the user has more emotional investment in the task, rather than performing a made-up scenario forced upon them.

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ID EA TI ON

Tasks Usability tests are not opinion polls, it is useful to ask for the users opinions at the end of the process but it must be task based to gain useful results. The below tasks explored this and are common to each round of testing, to ensure that the users were being tested on the same concepts. Any additional tasks will be outlined in the individual testing pages. Task 1: First Impressions

Task 3: Priming

The user is presented with the home screen, and without interacting with the interface they are asked to describe what they see, what they think and what they would interact with first.

The patch system is explained to the participant and then they are asked to prime the device, during this test an error message will appear, prompting the user that the patch is clogged and they must prime a new one.

“I’m going to ask you to look at this screen and tell me what you make of it: what strikes you about it, what do you think it is displaying , what you can do here, and what it’s for. Just look around and do a little narrative, but don’t click anything yet.” Measuring: Expectation

“The device uses a patch system, it is not too important for the purpose of this test to know exactly how this works but to prime the device it needs to be placed over the patch when prompted. Please could you proceed through the priming phase.” Measuring: Completion rate, Usability problems, Task time, Click count, errors

Task 2: Dosing The user is asked to dose an amount of insulin that they choose, if experienced with the treatment this may be a common value for them, if inexperienced this gives them an opportunity to think for themselves and not feel constrained by what they are being told.

Task 4: Health Card The participant is directed to find the health card in the device and suggest what this would be used for. “There is a health card contained within the device, could you find where it is located and suggest what would be included and for what purpose.” Measuring: Expectation, Usability problems.

“You are in need of an insulin dose, it’s just before lunch and you are with your family for a dinner. Please proceed as you feel appropriate.” Measuring: Completion rate, Usability problems, Task time, Click count, errors _ 81 _

I DE AT IO N

PROTOTYPE 01 INTER A CT I V E PD F Initial development of a prototype using an interactive PDF format. The data was taken from the wire-frame and an initial mock-up created in InDesign. The hyper-link tools were used to create links between pages in order to create a realistic prototype that mimicked the working device. The whole device has been mocked-up, including on screen representations of physical buttons. The user manipulates these as they would function in reality but receives no tactile feedback from them.

_ 82 _

ID EA TI ON

Information architecture 01 (pg. 70,71) was used as a basis for the prototype.

_ 83 _

I DE AT IO N

PARTICIPANTS USER PR OFILE S The below people were participants for the following test, for full profiles please see Appendix 03.

Colin Fricker

Claire Haydon

Age: 71 Diabetic: Yes Treatment: Insulin pen

Age: 46 Diabetic: Yes Treatment: Metformin

Kyle Dawney

Charles Palmer

Age: 22 Diabetic: No Treatment: N/A

Age: 21 Diabetic: No Treatment: N/A _ 84 _

ID EA TI ON

Images from User testing V1

_ 85 _

I DE AT IO N

Completion Rate (%) All users completed the dosing and health card activities with one failing to complete the priming task, this needed to be addressed as it is a fundamental flaw in the interface.

Dosing Priming Health Card

100

Time (Seconds without 10s required waiting time) Correlating with the patterns of the completion rates, the time shows that priming took the longest to complete, this is an area which needed to be addressed.

Dosing Priming Health Card

100

120

140

160

180

200

Errors (Number) Again, priming scored worst in this test too. However interestingly health card task experienced less errors than the dosing task, even dosing was completed quicker. There needs to be a balance between time taken to complete a task and the errors experienced along the

the though the way.

Dosing Priming Health Card

For raw results please see Appendix 03 _ 86 _

ID EA TI ON

Problems Observed problems and their severity. Problem

No. of cases

Severity

Action

Confirm injection needs a confirm action

Low

Select button is not obvious

Medium

Navigating backwards frustrates users

Low

Navigating backwards is necessary

Device needs a wider range of dose possibilities

High

Widen the dose range

Participants expect to use a touch screen

High

Investigate the viability of a touch screen

Implement confirm action Work on the select buttons identifier

Menu should circle around selections

Low

Ensure “up” from top of menu goes to the bottom

Always get back to home screen

Medium

Provide a “home” logo

Confusion in dosing process

High

_ 87 _

Re-evaluate the dosing process

I DE AT IO N

DESIGN DECISIONS PRO T OT Y PE 01 Priming Reduce the number of steps to ensure the process is as concise as possible. Dosing Streamline dosing process to allow user to administer in a shorter period of time. Dose range Some users can dose 10-20 units whilst others 70-100. Ensure the device allows this level of variation across doses. Menu Menu felt clunky and old fashioned, improve the action of accessing the menu. Home Allow the user to navigate back to the home button at any point in the process.

_ 88 _

Points changed (red) in the information architecture based on the design

decisions (left), reduced opacity area were kept.

Prime new patch

Remove patch

Home

Instant

Continue

Instant

Continue

Administer?

Prime

Priming complete

Bunch skin and insert into torso

Step 5

Yes

Patch ok?

Prime

Step 4

Instant

Back

Yes

Administer

Remove patch Prime new patch

X units delivered

Yes

Empty?

Clogged

Yes

Contact?

Home

Yes

Dose complete?

Yes

Battery?

Dose Place device over patch

Place device over patch

Instant

Continue

Scroll to select

Step 3

Instant

Back

Push cap to activate

Step 2

Instant

Back

Step 1 Slect dose

Step 1

Administer

Fill device with medicine

Prime

Scroll to select

Home

Low battery

Condition

About

Week

Yes

Name/age

Scroll to select

Health Card

Low battery?

Day

Scroll to select

Insulin History

Scroll to select

Information

History

Warning

Month

Patch information

IA 02 The major changes between IA 01 (pg. 70,71) and IA 2 (right) was a pop-up menu that is accessed over the home screen, priming and dosing were also condensed to improve flow of information.

Information architecture V2

I DE AT IO N

PROTOTYPE 02 INTER A CT I V E PD F Prototype 2 captures the information and feedback from the initial user testing to inform the next iteration. The inclusion of colour gave the interface a higher level of personality (could be changeable to the users taste, blue selected as it provides good contrast whilst being personable, medical and clean). On screen instructions in the form of speech bubbles helped to bring the device to life. The screen had become a lot more interactive, using more intuitive touch screen elements to aid the user journey.

10:10

40 40

Colibri

Administer Back

10:10

To dose

+ Continue Prime

10:10

place device over patch and hold inject button. Back

10:10

Fill device with medicament to be administered.

Dose Complete

Continue

40Iu

Last Dose 09:03

Back

Continue

_ 92 _

Push cap down to activate.

Back

Continue

ID EA TI ON

Information architecture 02 (Page 88,89) was used as a basis for the prototype.