Research + usability study
While I was researching diabetes at Dexcom, I came across a podcast of a woman speaking about how it’s harder to manage diabetes as a female. This became the driving inspiration for this study.
Objective: How can we benefit these users to have the knowledge to better manage their diabetes in relation to women’s health.
Methods: Generative research, in-person and remote interviews, unmoderated remote usability testing, co-creation, and journey mapping.
Deliverables: A journey map illustrating the challenges, feelings, and care of diabetes during the menstrual cycle. Report on pain points and opportunities throughout women’s cycles. Actionable insights on how to move forward, and a lo-fi interactive prototype.
Role: Defined project scope, designed and conducted interviews and usability tests, analyzed and synthesized data, generated reports, and designed wireframes and mockups.
Hypothesis
If women are provided an app to understand how and when their menstrual cycle is affecting their glucose levels, they will be more independent and proactive in managing their glucose variability.
This will reduce the amount of time outside of the ideal range.
Phase 1: generative research
Research outline
Objectives
Understand the patient's journey and identify the pain points in women's diabetes care as it relates to women's health. Then, learn how they can be addressed.
Understand how (or if) these women currently manage their cycle-related glycemic variability (highs and lows).
Competitive analysis of apps- uncover apps and websites users are using to help keep track of their menstrual cycle.
Identify what exactly these women need and what they would benefit from in order to take care of their diabetes in relation to women's health.
Produce a visual prototype either in the form of a wireframe or low fidelity design.
Participants
Women
Living with type 1 or 2 diabetes
Age (18- non-menopausal)
Half using hormonal birth control and half using non-hormonal birth control or none
Not pregnant
Uses intensive insulin therapy or a pump
On a CGM (Dexcom, Libre, or Medtronic) and not on CGM
Methodology
In person and remote one-on-one interviews with up to six Dexcom employees to understand the relationship between women with diabetes and their care. This will help provide a deeper understanding of the challenges these women face as well as how we might approach addressing these obstacles.
Homework assignment in the form a journey map to understand what these users are thinking, feeling, and doing during these milestones in their cycle.
Research insights
Types of participants
A1C: Reflects average blood sugar levels for the past two to three months.
General Themes
Periods are annoying and something they have to deal with.
Awareness of cycle characteristics is normally learned through personal experience.
Desire for a formula to treat their cycle-related highs.
Desire for records of what has been done in the past to combat highs due to their menstrual cycle.
Desire for insights and/or information showing them what has been working and what hasn't been working, and suggestions on what they could do.
Privacy is not an issue as long as it is communicated that the data is used responsibly.
Trends from Journey map activity
Trend insights
Formula- Desire for personalized formula to treat their stubborn highs.
Reminders- Reminders for preparing for supplies (tampons and pads) and period tracking.
Historical info- Desire for historical records on their cycle-related high glucose and how they treated it.
Trend insights- Users want to see their high glucose trends as it relates to the cycle and treatments as well as how might they treat their highs.
Structure and process
Participants spent 15-30 minutes completing a journey on what they experienced during their typical cycle as it relates to their menstrual cycle and diabetes care. Participants were asked to fill out each week according to the following categories: Thinking, feeling, doing, glucose behavior, diabetes care, and Opportunities
* Aggregation of the opportunities category from participant journey maps.
Recommendations for design
Patient/provider communication and education
Educational resources: Provide information or resources on women’s health and glycemic control.
Encourage communication: Promote communication with doctors on cycle-related glucose control.
Data accessibility: Allow for cycle information to be accessible in Clarity and viewable in relation to glucose data for providers.
Confidentiality
Responsible use of information: Ensure users are aware of how their information will be used. Consider terms and agreement page.
Platform
Consolidate data: Combine menstrual, glucose, and treatment data to help them troubleshoot their highs from month to month.
Historical view: Allows users to historically view how their glucose was behaving as it relates to their cycle and how they were treating it.
Data visualization
App partnership: Partner with an existing period tracking app to prevent reinventing the wheel.
Dexcom glucose data: Utilize Clarity glucose and trend information.
User data: Allow for user input data to be utilized such as insulin dosages.
Potential app features
Reminders: Reminders for preparation and inputting data.
Insights: Trends on glucose as it relates to the user’s cycle.
Decision support: Consider how Dexcom decision support can be incorporated.
Customization: Allow users to create custom notes and reminders.
Phase 2: usability testing
Research outline
Objectives
Determine whether app information is understandable.
Determine whether users understand the roles of each feature/button.
Determine the success on user flow and understand what needs to be changed.
Figure out the level of usefulness users find each feature.
Understand how the app and user might interact with each other, throughout the user’s journey.
Is this something that users would use to control their glucose?
Participants
Women
Living with type 1 or 2 diabetes
Age (18- non-menopausal)
Half using hormonal birth control and half using non-hormonal birth control or none
Not pregnant
Uses intensive insulin therapy or a pump
On a CGM (Dexcom, Libre, or Medtronic) and not on CGM
Methodology
In person interviews with two Dexcom employees to understand the relationship between women with diabetes and their care. This will help provide a deeper understanding of the challenges these women face as well as how we might approach addressing these obstacles.
Unmoderated remote usability testing to understand the usability of the proposed app prototype.
Interaction map to determine the timing and frequency of push/pull data.
The majority of participants experienced high glucose due to their cycle
Most helpful features
Time in range
was popular for participants for various reasons.
History
allows for participants to look back and compare.
Start of projected high glucose
the projected start for high glucose helps participants prepare.
Insights + patterns
was chosen by three participants as their first click
Most confusing features
Insulin graph
Participants didn’t know the insulin graph was for insulin.
Notes
Notes were unpopular because participants didn’t see themselves utilizing this feature.
Clue app
was confusing due to not being explained that it is the partnered app that would give the menstrual data necessary to give them insights.
End of projected high glucose
Some participants didn’t feel the projected end was useful to them.
SUS average score = 79.0 (C)
Word cloud
Participants chose 3-5 words from a predetermined list that described how they viewed the platform.
Useful (6) Easily learnable (6) Easy to use (4) Straightforward (3) Difficult to use (2) Will take some time to learn (1) Complicated (1) Informational (1)
Recommendations for design
Quick access and accessibility
Add cycle data on homepage: Determine what cycle-glucose features could be accessed on the homepage
Graph
Monthly graph: Consider other potential ways to visualize important cycle-related glucose information in a monthly view.
Insights and patterns
Placement: Consider moving insights and patterns to a more easily accessible area
Notifications: Provide notifications on insights + patterns of cycle-related glucose.
Time in Range
Current TIR: Make it clearer as to what time frame each TIR is for (time frame & time period).
Notes
Add notes placement: Consider notes being added for any type of event.
Recorded notes placement: Consider re-locating the notes tab to another area that aligns with the priorities of the user.
Meatball icon
Icon: Change to a plus sign
History
Change orientation: Consider different ways to visualize historical time in ranges.
Unexpected insights
Participants do not consult their doctors about their high glucose related to their menstrual cycle.
Users need to be fairly controlled before addressing cycle-related high glucose
Not much can be done to proactively prevent high glucose other than routinely exercising. Correction of high glucose is done in the moment (eating less carbs and augmentation of doses).
PCOS is linked to type 2 diabetes, but is also found to contribute to insulin resistance.
Age may play a role in motivation and acceptance- more research would be required to confirm.
What could have been done differently
Due to the time constraints and small size of this research and usability study, more participants for the next round of research is necessary.
The majority of participants in this study were Dexcom employees. The study would have benefited from participants that better represented the target population.
Due to the project size, I was the sole designer of the wireframe mockups. If we were to do this study over again, it would have been better to have someone else design while I do the analysis.