Empowering people living with type 1 diabetes to travel with confidence
*** Note: This article was written in April 2020 by myself and two fellow teammates, but we never got around to publishing it…until now! Upon revisiting some of my past projects, I decided to finally share this great piece of work that was the pride of my last year of undergrad. Enjoy! ***
During our final year in the undergraduate Industrial Engineering program at the University of Toronto, we had the pleasure of working on a capstone design project with Healthcare Human Factors to design a solution that would tackle the challenges that people living with type 1 diabetes (T1Ds) face while travelling. Here, we take you through our iterative design process and showcase some of the insights we have learned from the T1D community.
Travelling with type 1 diabetes
There are over 20 million people living with type 1 diabetes around the world. Despite its high prevalence, innovations for this community are sometimes not practical, accessible, or affordable, and don’t always address the unique challenges they face. One particular problem area is travelling. While a vacation trip to Mexico might mean relaxation and enjoyment for most people, it can mean stress and anxiety for T1Ds.
The additional planning and uncertainty associated with travelling often detracts from an ideal experience. Although there are resources out there that do provide T1Ds with helpful tips and advice, such as online forums and articles, in many cases they only address limited aspects of the travel journey, and are impersonal to their itinerary, treatment plan, and personal preferences. The onus is often placed on the user to actively seek out information that is relevant to their situation. These travel-related factors can cause certain stressors and trigger emotional responses, often classified as diabetes distress. We aimed to develop a solution that would decrease this distress and increase their overall confidence in travelling.
In order to address some of the specific challenges that T1Ds experience, we used a user-centered design approach to understand and empathize with users, then iteratively design and prototype a solution that would help T1Ds throughout their entire travel journey.
Gaining in-depth insights from T1Ds
It was incredibly important to gain deeper insights from T1Ds in order to uncover the underlying factors that influence their travel experiences. By conducting 1-on-1 interviews, we created a safe and open environment where T1Ds were comfortable with sharing their lived experiences and were able to express how these challenges affected them on an emotional level. At the end, we were left with five key takeaways that influenced how we approached this problem:
- Inherent fear and anxiety are associated with the first few trips.
- Feelings of fear and anxiety intensify when travelling to an unfamiliar destination or a remote location.
- Most of the stress is generated during the planning phase, especially since it involves thinking about worst-case scenarios.
- T1Ds rely heavily on supports and resources to help them prepare for their first few trips.
- Travel companions ease the travelling process by providing support throughout.
The interviews also provided an insight into the main challenge areas that T1Ds encounter while travelling:
Awareness and Control of Blood Glucose Levels. Determining how unfamiliar foods, activities, or time zone changes affect blood glucose levels can put T1Ds in a stressful and precarious situation.
Getting Help in an Emergency Situation. Knowing where the closest hospital is or figuring out the operating hours for a pharmacy can be tough, especially if they are in an unfamiliar location.
Making a Detailed Medication List. Not only do T1Ds keep a record of medication and insulin pump settings being used, but they may also have to anticipate that certain countries may have different names for the insulin they use.
Navigating Airport/Border Security. If security personnel are unfamiliar with type 1 diabetes, T1Ds may receive questions about their insulin pump or snacks that they are bringing, which can be a frustrating and uncomfortable interaction.
Gathering of Supplies. Figuring out what insulin pump and glucose monitoring supplies are needed and determining how much they should bring as a backup can be a daunting task.
Storage of Supplies. Ensuring that their supplies are kept at the right temperature and remain intact can be challenging, especially if encountering varying environmental conditions.
Icons provided by Flaticon.
Journeying on with JourneyOn
To address the insights and challenges that were brought up during the interviews, we developed a mobile travel companion called JourneyOn. JourneyOn is a mobile application that guides T1Ds through the entire traveling process, from planning and preparation to getting around their destinations. JourneyOn helps facilitate a seamless travel experience by alleviating the burden of gathering and packing supplies, improving interactions with security authorities, and providing resources to navigate a variety of different travel situations.
Our user-centered process helped shape the design from some initial rough sketches to a higher-fidelity prototype that showcases what an ideal T1D travel companion product might look like. The design places emphasis on:
- Personalization and customization. The most important aspect of the solution is being able to tailor each resource/feature to the user, based on their specific trip itinerary and personal information. This means making any tips, advice or suggestions directly relevant to the user — no more of that generic stuff!
- Ease of use and reduced workload. User input methods are made as easy and convenient as possible to avoid putting additional burden on the user. Third party integrations also allow information to be imported from other applications, which help streamline and simplify the entire process.
- Empowerment over enforcement. JourneyOn uses language that carefully frames things as suggestions rather than dictates what users can or cannot do. JourneyOn is not a medical device or expert authority; it is simply a helpful tool that guides and facilitates, giving users full control over how they use the information and resources provided.
The goal of JourneyOn is to reduce overall levels of diabetes distress throughout a T1D’s travel journey. The application uses elements of playfulness in language, tone, and colour on top of a clean and simple interface to provide a delightful user experience. Our hope is that a product like JourneyOn would allow users to feel less burdened by the stresses of travelling with T1D, and ultimately inspire more confidence in travelling.
What we learned from usability testing
With our JourneyOn application prototype, we conducted usability testing sessions with a total of five participants, ranging from ages 15 to 58 and including both T1Ds and their caregivers. An effort was made to recruit participants who were more recently diagnosed, therefore not having a significant amount of experience travelling.
We wanted to capture their emotional responses through the T-PAID scale, which is a travel-related version of the Problem Areas in Diabetes (PAID) scale that measures diabetes distress. Users were asked to fill out a questionnaire that measures their T-PAID score, before and after they used the prototype. The results showed a mean reduction of 23.5 points (SD = 14.9) in travel-related diabetes distress, where a 10–15 point reduction is an indication of an effective intervention.
A system usability score (SUS) questionnaire was then given to participants to assess the overall usability of the prototype, with a resulting mean SUS score of 88.0 (SD = 10.8) on a scale of 100.
Participants also provided qualitative feedback on the features within the application and their overall experience with it, for example:
- When collecting user information, it was important to provide some indication of how it would be used within the application
- Participants emphasized the value of including these features:
- Ability to share trip itinerary/information with others
- Customizable to-do list
- Notifications/reminders for upcoming activities and tasks
- Translations of important phrases and medications
- Ability to find and save locations of interest specific to T1Ds
- Connecting with other T1Ds in the area
Considerations for the future
The user-centered design process is an iterative one. Although we’ve converged on a potential solution, there is still room for further research and testing. Given more time, we would suggest continuing to test the design with users in order to hammer out potential usability issues, and validate any design changes that were made based on feedback received during testing.
One of the biggest challenges in this process was finding representative users who were willing and able to participate in our studies. While we still gained valuable insights from the small group of T1Ds/caregivers who did participate, a larger variety of participants might have given a more in-depth representation of specific needs across the T1D/caregiver population. In an ideal world, we would continue to talk with as many users as possible to validate our design.
In terms of useful features and functionalities, there are several areas for consideration we think would be nice to explore in the future:
- Account sharing & collaboration. A recurring theme among participants, especially caregivers of PWDs, was concerning functionality that would support the dynamics of a caregiver-PWD relationship, especially in the case of a parent who might be using the application for their young/dependent child.
- Social connecting & community networks. Our design incorporates aspects of social connection through a rudimentary “locate other users” feature, but this was intended more for peer-to-peer support in emergency situations. It would be interesting to explore the potential of building a more extensive JourneyOn community or support network to enhance the overall user experience.
- System robustness & information quality. Making the application more robust in handling the storage of trip information should be kept in mind as it is used over time. Resources play a major part in the application, so making sure that the information JourneyOn provides is rich, comprehensive, and kept up to date should be a top priority.
Beyond the design of JourneyOn as a potential solution for helping T1Ds travel with greater confidence, we hope that our research inspires others to address these kinds of unique experiences using a user-centered design approach to empower the greater diabetes community.
Check out the full JourneyOn prototype here: https://bit.ly/3bgaiWe
About the Authors
This blog post was written by Ryan Cheng, Meggie Debnath, and Lauren Ip as the result of a 4th year Industrial Engineering undergraduate capstone project at the University of Toronto. Special thanks to our supervisor, Mark Chignell, and client, Joe Cafazzo at Healthcare Human Factors, for their valued support and guidance throughout this project.
