DIMA: Designing Assistive Technologies for Dialysis Patients

DIMA (Dietary Intake Monitoring Application) is a proofof-concept personal digital assistant application for dialysis patients to monitor their fluid and sodium intake. Dialysis patients can only consume 1 liter of fluid and two grams of sodium each day. Patients who do not comply with their dietary restrictions run the risk of hypertension, pulmonary edema, and death. Currently, patients try to remember or write down in a food diary their fluid and sodium consumption. However, these techniques are insufficient because 80% of patients are unable to restrict their fluid intake. My dissertation focuses on designing a framework for usability studies in non-traditional environments, integrating technology into chronically ill populations who do not ordinarily use technology, and designing an interface for people with low literacy skills. INTRODUCTION Think about everything you ate today. How much fluid did you drink? Remember to include your morning cup of coffee, soda at lunch, sip from the water fountain, and the ice cream from dessert. How much sodium did you consume? Did you consume more than a liter of fluid (approximately three cans of soda) or a couple grams of sodium (approximately two paper clips) today? If you think figuring out the answer to these questions are difficult, you are not alone. Dialysis patients all over the world have trouble with these calculations. However unlike you, if a dialysis patient miscalculates their fluid or sodium intake, they run the risk of hypertension, pulmonary edema, and death. ∗Katie A. Siek is supported in part by a National Physical Science Consortium Fellowship and by a stipend from Sandia National Laboratories/CA. Many thanks to Kay H. Connelly and Yvonne Rogers for their support and guidance. The amount of fluid and sodium consumption allowed varies among patients Currently patients keep track of their fluid and sodium intake by remembering or writing/drawing what they eat in a food diary. Welch et al. has shown that these techniques are insufficient since 80% of motivated patients are unable to restrict their fluid intake[7]. Research has shown that 1/3 of dialysis patients have difficulty performing simple calculations [2], let alone more complex calculations such as conversions between units of volume (i.e. fluid ounces to liters). We are creating a proof-of-concept personal digital assistant (PDA) application called DIMA (Dietary Intake Monitoring Application) for dialysis patients with low literacy skills and limited technology experienced to monitor fluid and sodium intake. Patients can select food icons on the PDA screen or scan food Universal Product Codes (UPCs) to easily input food. Monitoring fluid and sodium levels could help patients monitor their dietary intake and improve their quality of life. Challenges and Contributions The biggest challenges associated with developing DIMA are that our user group has low literacy skills and little computer skills. More importantly, we are training and conducting usability studies in a busy dialysis ward during treatments. Our research can contribute to the field of computing by: • Creating a framework for usability testing in nontraditional environments focusing on discussion techniques [1] • Building on methods to integrate technology into user groups that do not ordinarily use technology via incremental games • Designing a simple interface with lots of information (i.e. possible dietary consumption) for people with low literacy skills using iterative design methodology Originality of Work While there have been many studies regarding handheld devices in health care, to the best of our knowledge our application will be the first dialysis intervention to use a handheld computer. Previous dialysis interventions have focused on patient counseling or hands-on education in a clinical setting. Our intervention will always be with the patient giving them direct feedback on how their diet effects their fluid and sodium levels.