1.5.1 Contribution of dissertation
By mixed methods research with focus on individual users, basic mechanism of users’
engagement with a personal-use based mHealth application for self-management of T2DM, the Few Touch application, was explained. Engagement here means actual usage of the application by recording relevant data to self-management, and utilization of both the recorded data and the application in the context of self-management. The Few Touch application served as a flexible learning tool for users to instantly confirm how their self-management activities and/or health status influenced their blood glucose levels. While the common mechanism was explained, heterogeneity of patterns and level of engagement both among users and over time was also confirmed. Various factors associated with usability of such application were identified. The study also indicated that users’ backgrounds both
directly and indirectly relevant to the problem domain have a strong influence on the usability.
Thereby this study contributed to fields where personal-use based mHealth technologies for self-management of T2DM using a similar smartphone are designed, developed and used, by providing the following implications:
Importance of clarification of users’ engagement with mHealth technology regarding its difference among users and its change over time.
Importance of involving people with T2DM that have different needs and
background both directly and indirectly relevant to the problem domain, namely self-management of T2DM in a design process. The involvement should be throughout design and development process until a long-term testing of a working prototype to discover latent problems that could otherwise not be manifested.
Potential of efficient and effective discovery of usability flaws stemming from design of a mHealth application by including healthy volunteers in pilot usability testing.
This is due to their low or no motivation for use of tested mHealth application. Such testing should focus on very fundamental simple tasks requiring no experience as being diagnosed as T2DM or relevant knowledge to self-management of T2DM.
Testers should however have various backgrounds as people with T2DM.
Table 1.1 presents details of contribution of dissertation in the form of a list of key findings, phases where the findings were led from, and associated research questions.
Table 1.1 Details of contribution of dissertation: how key findings are associated with research question(s) and where the findings are addressed
# Findings Addressed in
Phase(s) and paper(s)
Research question
F1 There were considerable differences in usage of the Few Touch application in terms of usage pattern and level of engagement, and in addition they changed over time
Phase 1, 2 (Paper 2, 3)
R1
F2 Motivation to use the application is a result of balancing between the expected effort required to use it and the expected benefit, mainly learning about user’s T2DM,
Phase 1, 2 (Paper 2, 3)
R2
14 by using the application.
F3 Factors that reduced effort required for self-management of T2DM while enhancing learning about a user’s T2DM seemed positively associated with usability of the Few Touch application.
Phase 1, 2 (Paper 2)
R3
F4 Usability of the Few Touch application is strongly influenced by individual user’s needs and various types of backgrounds both directly and indirectly relevant to the problem domain that the application addresses.
Phase 1-3 (Paper 2, 3, 4, 5)
R4
1.5.2 Included papers
Literature review of related works and Phase 1 and 2 resulted in published papers through peer-review process. Major findings in Phase 3 are summarized into a manuscript which is under review process when this dissertation is submitted. Therefore, including this manuscript by calling it Paper 5 for convenience, I will include five papers listed in Table 1.2
Table 1.2 List of included papers
# Paper title, forum and authors
Paper 1 “A Review of Mobile Terminal-Based Applications for Self-Management of Patients with Diabetes”, eTELEMED’09 (Tatara N, Årsand E, Nilsen H, Hartvigsen G) Paper 2 “Long-Term Engagement with a Mobile Self-Management System for People with
Type 2 Diabetes”, JMIR Mhealth Uhealth (Tatara N, Årsand E, Skrøvseth SO, Hartvigsen G)
Paper 3 “Usage and Perceptions of a Mobile Self-Management Application for People with Type 2 Diabetes: Qualitative Study of 5-month Trial”, Studies in Health Technology and Informatics. 2013;192:127-31 (Tatara N, Årsand E, Bratteteig T, Hartvigsen G) Paper 4 “Patient-user involvement for designing a self-help tool for Type 2 diabetes”,
Therapeutic Strategies A Challenge for User Involvement in Design: Workshop in conjunction with NordiCHI2010 (Tatara N, Årsand E, Hartvigsen G)
Paper 5 “Making it Easy is not so Easy: Interaction Design with Text and Image on a Small Screen” submitted to CHI 2014 (Tatara N, Bratteteig T)
Below is the description of each paper with its relevance to this dissertation and my contribution.
Paper 1: Tatara N, Årsand E, Nilsen H, Hartvigsen G. A Review of Mobile Terminal-Based Applications for Self-Management of Patients with Diabetes. Proceedings of
International Conference on eHealth, Telemedicine, and Social Medicine, 2009. (eTELEMED '09), Page(s): 166 – 175, 2009
Relevance to this dissertation: This paper presents the literature review of related works and summary of findings at the time of summer 2008. The review provides a broad overview of the research works in terms of; target users, use of technologies, design of mHealth, and study designs such as methods of intervention and other types of evaluation of mHealth. The summary of findings became the basis of evaluation and design improvement of the Few Touch application, as used in Phase 1 and 2.
My contribution: I conducted all the works and wrote the manuscript by consulting to the co-authors regarding interpretation of findings in collected papers for a synthesis.
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Paper 2: Tatara N, Årsand E, Skrøvseth SO, Hartvigsen G. Long-Term Engagement with a Mobile Self-Management System for People with Type 2 Diabetes. JMIR Mhealth Uhealth 2013;1(1):e1
Relevance to this dissertation: This paper presents mechanism of participants’
engagement with the Few Touch application by analyzing data from the first 56 weeks of Trial I. It also presents design factors associated with long-term usage and usability of the application. Therefore, the paper has the major relevance to the dissertation.
Details of results are presented in the paper and its appendices.
My contribution: I am a main contributor in writing the paper and in revision based on comments and questions given by the reviewers for the first round of the reviewing process. As written in “Authors’ contributions” section in this paper, I contributed in:
“conception and design of the present work, namely analysis of the results from the long-term trial”; “developing protocols for data collection”; “data collection”; and
“data analysis” in addition to writing and revision.
Paper 3: Tatara N, Årsand E, Bratteteig T, Hartvigsen G. Usage and Perceptions of a Mobile Self-Management Application for People with Type 2 Diabetes: Qualitative Study of 5-month Trial. Studies in Health Technology and Informatics. 2013;192:127-31.
Relevance to this dissertation: This paper presents a summary of the results of analyses of data from the Trial II. Due to the limited space of this conference paper, extended summary of results are presented in chapter 7.
My contribution: I wrote the paper and revised based on comments and questions given by the scientific program committee for the reviewing process. I am also a main contributor in designing the questionnaire, data collection and analysis.
Paper 4: Tatara N, Årsand E, Hartvigsen G. Patient-user involvement for designing a self-help tool for Type 2 diabetes. Proceedings of Therapeutic Strategies A Challenge for User Involvement in Design: Workshop in conjunction with NordiCHI2010, ISSN 0105-8517, Pages: 53-55, 2010
Relevance to this dissertation: This position paper is a short description about Trial I, but it provides with discussion which is very much relevant with Finding 4. The
discussion was very much inspired by results of the workshop.
My contribution: I participated in the workshop by presenting this position paper. I wrote and revised the paper.
Paper 5: Tatara N, Bratteteig T. Making it Easy is not so Easy: Interaction Design with Text and Image on a Small Screen. Submitted to CHI 2014.
Relevance to this dissertation: This paper reports from most of the results in Phase 3:
Inquiries 3 and 4, concept design, working prototypes and the pilot usability testing.
Due to the limited space of this conference paper, extended summary of results are presented in chapter 8. It has therefore foci on the Finding 4.
My contribution: I contributed to planning and conducting all the works described in the paper. For the works done in collaboration with others, the published works are referred. The ones who did the works described in collaboration with me are