User profiles and personas in the design and development of consumer health technologies

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Abstract

Background

“The graying of the globe” has resulted in exponential rise in health care expenses, over-worked health care professionals and a growing patient base suffering from multiple chronic diseases, one of which is diabetes. Consumer health technologies (CHT) are considered important catalysts for empowering health care consumers to take a proactive role in managing their health and related costs. Adoption rate and usability of such devices among the aging is far from being satisfactory. Past studies noted the motivation for adoption by the aging is dependent on the suitability/relevance, perceived usability and anticipated benefits associated with usage of technological innovation. Traditional information technology (IT) development adopts a systematic approach without necessarily using a specific user model that personalizes the system to the aging user groups. The aging patient population has unique needs arising from progressive deterioration in both physiological and psychological abilities. These needs are often ignored in the design, development, trial and adoption of consumer health products resulting in low adoption and usage.

Objectives

The main objective of this research is to investigate the user-centered design (UCD), specifically user profiles and personas, as methodological tools to inform the design and development of CHT devices for an aging population. The adoption of user profile and persona has not received much attention in health care informatics research and, in particular, research involving CHT. Our work begins to fill this void in three ways. We (1) illuminate the process of developing CHT user profiles and personas for a Chinese elder population with a demanding health care needs, i.e., self-management of chronic diabetes, with the hope that the resulting profiles and personas may be used as foundational material for informing the design, development and evaluation of CHT in other similar contexts; (2) call attention to how to further enhance and complement traditional user profile and persona techniques for CHT design by integrating cognitive structures and present behavior that drive health care thinking, future behavior and demand; (3) show how the profiles and personas can be used to inform requirements, design and implementation decisions for a technology aimed at facilitating CHT adoption and diffusion for the elderly.

Methodology

To exemplify process and application, we use an action-research methodology, where user profiles and personas of an aging patient population were developed. The resultant profiles and personas were leveraged to improve the design, development and implementation plans of a smart phone application to assist chronically ill aging Chinese diabetic population capable of disease self-management.

Results

The results from the study show that user profile and persona can be a valuable methodological approach in capturing the conceptual model of the aging and informing the design and development decisions of CHT. The demonstration of techniques used in this study can serve as a guideline to CHT developers in bringing conceptual user modeling into the design of software interfaces targeted for users with specific health care needs. Specifically, the study provides guidance on the creation and use of profiles and personas to tap into the conceptual models of the targeted elderly population reflecting their preferences, capabilities and attitudes towards using technology in self-management care in general and the smart phone diabetes management application in particular. Insight into the mental model of the aging group has been shown to inform later stages of UCD development (e.g., the creation of prototypes and usability testing) as well as implementation and adoption strategies. The World Health Organization (WHO) predicts that by 2025, 80% of all new cases of diabetes are expected to appear in the developing countries. In fact, the number of diabetic patients in China is estimated to rise to 42.3 million in 2030 from 20.8 million in 2000. Thus, we investigate the Chinese aging population in order to demonstrate the process of developing and using user profile and persona. We hope that the resultant conceptual model of the Chinese aging diabetic population can be used in future research to guide CHT designers interested in designing health care devices for this vulnerable user group.

Introduction

In the wake of the 21st century, health care systems around the globe are faced with exponential rise in expenses, heavy utilization of services and limited financial as well as human resources [see [1] for an example of when this is not the case]. Another trend observed parallel to the rising health care costs is the “graying of the globe.” The worldwide population of adults over 65 years of age is on the rise and expected to reach 761 million by 2025 [2]. Several studies in the past have noted the prevalence of multiple chronic diseases and co-morbidities in the aged population [1]. In the US, high-risk aged patients account for approximately 78% of all health care spending—well over a trillion dollars per year and/or over two-thirds of Medicare's annual spending [3]. A critical inference drawn from epidemiological data is that preventing occurrences of acute episodes and managing health care needs of the aging patient population holds the key to providing quality health care and reducing unnecessary health care expenses. In order to reduce preventable acute episodes from occurring it is critical to focus on preclusion of complications, proactive management of illnesses and timely detection of anomalies such that aging patients can actively participate in the management of their health care and lead a normal, healthy lifestyle outside of the hospitals [1], [4].

Consumer health technologies (CHT) have the potential of empowering aging consumers to take a proactive role in managing their health and related costs. In the recent past, there has been an influx of technological tools and devices that attempt to educate and engage patients in their health care process. However, successful usage and adoption of these technological devices is fairly poor in the aging patients—which accounts for a large proportion of customer base for innovative health care devices.

Aging involves progressive deterioration in both physiological and psychological abilities, creating special needs among the aging population segment. In addition to age-related issues, a large proportion of the aging populace suffers from multiple chronic diseases and co-morbidities [1]. These needs are often ignored in the design, development, trial and adoption of consumer health products resulting in low adoption and usage among the aging adults [5]. This population segment not only requires more time, practice and technical assistance to acquire computer skills, they are also more error-prone than the younger generation as a result of detriments in visual, perceptual, psychomotor and cognitive abilities [6], [7].

Information technology (IT) and age-related challenges in the aging population can, in part, be compensated by designing senior-friendly applications. In order to design and develop health care products that meet the unique requirements of the aging patient segment there exists the need to (1) analyze/understand the challenges and requirements of the elders; (2) study and implement methods of making information communication technologies (ICT) accessible to elder user group; (3) model and integrate preferences of the elder population segment into health technologies; and (4) evaluate outcomes. Involvement of the elder population in each of these four phases and compensating for age-related differences by developing senior-friendly hardware and software interfaces can increase the acceptance, usefulness, information quality and utilization of IT applications [8], [9].

A characteristic of the traditional IT design methodology is the limitation of user participation to a consultative role, where the bulk of the design decisions are made by the IT designers and/or developers who tend to be younger adults [10], [11]. Systems designers and developers can potentially “ground” themselves (described by psychologists as “a human natural behavior of finding a known reference point in a foreign information space,”) and run the risk of designing an interface for themselves, i.e., younger adults, rather than the user groups—older adults [7]. This dependency on the mental model of the younger adults in designing/developing applications for older adults results in sub-optimal applications with low usage/adoption rate by the aging patient population. Additionally, it has been found that the younger adults tend to under estimate and under appreciate the potential challenges of the aged. Consequently, the design and implementation of computer applications are often unsuitable and irrelevant for the aging populace [6]. Furthermore, the aging populace suffering from multiple chronic diseases have additional needs and challenges which might not be understood by the design team consisting predominantly of younger adults with little or no exposure to chronic illnesses. Past studies have noted that the motivation for adoption by the aged population is largely dependent on the suitability and relevance, perceived usability and anticipated benefits associated with usage of a technological innovation [5], [6], [7], [8]. Roberts et al. [9] indicated that usability of applications depend 10% on the visual aspect of the product (the “look”), 30% on the aspect of user interaction with the product (the “feel”) and an enormous 60% on the applications’ aspects meeting/exceeding the user's mental model. In order to develop applications that are functional and usable, it is imperative to reach the level of personal connection that captures the essence and issues of aged patient groups by creating a reasonable approximation of their conceptual models.

Traditional IT development adopts a systematic approach without necessarily using a specific user model that personalizes the system to one or more user groups. Research and practice of end-user computing in IT development have emphasized the importance of end-user participation and involvement [10], though not much attention is given to formalized conceptual models of users as a design methodology. Furthermore, utilizing formalized conceptual models of the aged populace as a design methodology has received little attention in past research. In this study, we seek to investigate the utility of user profile and persona as a methodological tool to develop an in-depth understanding of the limitations and possibilities of the aged patient populace. The resultant conceptual model of the aged patients can be leveraged to inform design and development decisions of CHT.

User-centered design (UCD) is a modern human-computer interaction (HCI) design philosophy. It is a multi-stage, problem-solving process in which the needs, desires and limitations of users are inquired and analyzed. Assumptions of user behavior are transferred into prototypes that can then be tested. UCD techniques such as user profile and user persona are structured ways of typifying a group of users in text and pictorial formats (i.e., conceptually modeling the end users). User profiles and personas go well beyond demographics, as they attempt to “capture” the user's mental model comprising of their expectations, prior experience and anticipated behavior. They attempt to understand intended CHT users—not just their demographics, but also how they think, feel and behave. This is critical to successful consumer health application adoption. Profiles and personas can either be used as part of an entire UCD methodology or they can be used to enhance existing methodology by introducing user-centered thinking into the design and development process [11].

Despite potential benefits, the use of user profiles and personas has not received considerable attention in health care informatics research in general and development of CHT in particular. Also, UCD user profile and user personas have received little or no attention as a methodology to inform the design and development of applications in the context of aged patients despite several studies’ finding that assistive applications for the aged population segment should consider user-specific context, physical/cognitive impairments, differential motivational factors and perceptions of self-efficacy [12], [13]. Given this background, the specific research questions addressed in the current study are:

  • 1.

    How can the existing UCD tools, user profile and persona, be incorporated/enhanced in the context of capturing the conceptual model of health care technology users?

  • 2.

    How can the conceptual model of the aged population segment be captured in user profile and user persona?

  • 3.

    How can the captured conceptual model be utilized to facilitate system analysis, design, development and implementation of CHT?

To address these research questions, we use an action-research methodology to exemplify the creation process for user profiles and personas and help illuminate how these tools may be used in the context of UCD, particularly for CHT for the elderly. The action research context is a field study involving the aged Chinese diabetic population demonstrating the value and application of two UCD tools – user profiles and personas – as a part of the methodology to develop an application to assist the target users in self-management of their chronic condition. Diabetes is one of the primary causes of premature death and adult disability worldwide; the death rates are predicted to rise by 20% over the next decade [14]. The total number of people with diabetes in the world is projected to grow from 171 million in 2000 to 366 million in 2030 [15]. World Health Organization (WHO) predicts that by 2025, 80% of all new cases of diabetes will appear in the developing countries. The prevalence of diabetes in the Chinese population increases with age: 4–5% in adults of working age, 10% in subjects over the age of 60 and 17% in those over 75 [16]. Currently, there are 130 million Chinese over the age of 60 and by 2030, the number is estimated to reach 336 million [17]. The rise in the number of diabetic patients in China from 20.8 million in 2000 to an estimated 42.3 million in 2030 is deemed to have a considerable impact on the global burden of diabetes [18].

This study demonstrates (a) how to effectively involve an aged patient population in the design and development of CHT; (b) how to develop user profiles and personas of an aged patient population; and (c) the utility of user profiles and personas as a methodological tool in not only capturing the mental model of the aged Chinese diabetic patients but also in assisting the development team by informing the design and development decisions of CHT. This level of understanding/communication between the user group and the development team holds the key to synergetic design, development, adoption and meaningful usage of CHT by the intended users.

The next section provides the background knowledge in the context of the current study. Section 3 provides details of the research methodology focusing on our action research context. Section 4 presents the results of the field study and discussion of the implications of the resulting data. Section 5 provides a summary of conclusions that highlights insights for further application of the process described and resulting artifacts in future practice and research.

Section snippets

Background

This study is motivated in the current health care crisis characterized by an exponential rise in elderly patients suffering from co-morbidities coupled with a parallel rise in health care costs. CHT have been widely recognized as a means of empowering aged patients and promoting proactive management of diseases [8]. Despite the potential benefits, CHT have achieved mixed success with respect to usability and consumer satisfaction. One study reported on the non-effectiveness of 72 consumer

Methods

The main objective of this research is to investigate the user-centered design (UCD), specifically user profiles and personas, as methodological tools to inform the design and development of CHT devices for an aging population. We utilize an action-research approach to exemplify the process of developing user profile and persona of aging Chinese diabetic population. The applicability of user profile and persona of the aging Chinese diabetic population in assisting and informing the design,

Augmenting “Traditional” technology user profile and persona characteristics (R1)

The final schema for coding and identifying user profile and persona attributes of significance to arrive at our conceptual model of CADA users is provided in Fig. 2. The attributes presented in this model are derived from profile and persona literature, technology usability literature, health care literature and data from this study. Our model demonstrates that technical, demographic and specific heath care characteristics need to be considered to adequately capture the mental model of CHT

Conclusions

Elders have specific capabilities, limitations and experiences that affect their interactions with technologies. CHT have the potential to provide value in providing proactive support in disease management if they are adopted and used by elders. However, many challenges remain to develop technologies that meet the needs of older adults, accommodate their cognitive and perceptual declines, capitalize on their intact abilities, support them in performing everyday activities, and protect their

Authors’ contribution

Cynthia LeRouge—As the lead author, she conceptualized and organized the paper. She performed data collection and analysis for the referenced study and contributed to the development of the exemplified user profiles and personas. Jiao Ma—As the second author, she performed data collection and analysis for the referenced study and was the lead in development of the exemplified user profiles and personas. Sweta Sneha—As the third author, she contributed to the development of the manuscript from

Conflict of interest

No authors had any financial and personal relationships with other people or organizations that could inappropriately influence (bias) this work.

Acknowledgement

We thank Microsoft Research (Award Number 16400) for funding this project.

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