O'Kane, AA; (2016) Individual differences and contextual factors influence the experience and practice of self-care with type 1 diabetes technologies. Doctoral thesis , UCL (University College London).

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Abstract

Adults with Type 1 Diabetes have choices about what technologies to use to self-manage their chronic condition. They can use glucose meters, insulin pumps, continuous glucose monitors, smartphone apps, and other mobile technologies to support their everyday care. However, little is known about how user experience might influence what they choose to adopt or how they choose to use technologies when practicing self-management. A series of situated exploratory qualitative studies were conducted to examine contextual factors that influence the use of self-care technology “in the wild.” Autoethnography was used to gain empathy for the everyday use of a mobile medical device and to set up a mixed method user study, involving contextual interviews, a diary study, and the observation of a diabetes technology group meet-up. A combined bottom-up thematic analysis of the data from the user studies uncovered commonalities among the users in how context influenced the use, carrying, adoption, and misuse of these devices. However, large variability in how user experience impacted self-care for the 41 participants was also revealed. Although these self-care technologies were effective, efficient, and easy to learn for the participants from a human factors engineering perspective, context specific issues arose that impacted decisions to use them. The physical environment, the social situation, the cultural context, and individual differences influence these choices. Quality of life can be impacted by the design of Type 1 Diabetes technologies, and people sometimes prioritise quality of life over immediate or long-term health benefits. This research points to the need to study the use of these mobile medical devices in-situ to understand how their design can influence adoption and use in everyday life. However, the variety of everyday self-care contexts and the diversity of possible user preferences do not lead to straightforward or universal design implications. Future work should look at the influence of design of other self-management technologies that are being developed to deal with the move of healthcare outside of clinical settings and focus on empowering adults to make personal choices about their self-care technologies that suit the context of their, sometimes messy, everyday lives.

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