Co-Designing Food Trackers with Dietitians: Identifying Design Opportunities for Food Tracker Customization Yuhan Luo, Peiyi Liu, Eun Kyoung Choe College of Information Studies & Human-Computer Interaction Lab University of Maryland, College Park
36 th HCIL Symposium Yuhan Luo 2 2 Image source: What’s the best App for Tracking Calories?
What do people track about their food? Snacks Calories Nutrition facts Regular meals (e.g., protein) Time Location People Feelings [Grimes & Harper, 2008] Yuhan Luo 3
Health providers: the values of food tracking data • Assess nutrient intake • Perform diagnosis • Provide treatment [Gubney, 1997; Ma et al., 2003; Matthys, 2007] Image source: 5 things your dietitian wants you to stop doing Yuhan Luo 4
Patients: tracking needs vary by health conditions Obesity ! (Ma et al., 2002) Irritable bowel syndrome (IBS) " Eating disorder # (Eikey et al., 2016) (Chung et al., 2015) Image source: [1] Abdominal pain for irritable bowel syndrome. [2] Medical News Today [3] WHERE DID MY APPETITE GO? Yuhan Luo 5
The design of mainstream food tracking apps MyFitnessPal My Food diary Yuhan Luo 6
The mismatch between current tracker design & individuals’ tracking needs: Impeding the effective use of patients’ data • Unintended consequences (e.g., over-restricting) • [Chung et al., 2015; Eikey et al., 2017] Yuhan Luo Image source: Matching subjects and verbs 7
The opportunity: Designing customizable tracking tools to support diverse tracking needs & provider-patient collaboration Yuhan Luo Image source: Matching subjects and verbs 8
Research Questions 9
RQ1. What do patients with dietary problems need to track to facilitate working with dietitians? ( Tracking needs ) RQ2. How to customize food trackers to support patients with various dietary problems? ( Tailoring tracker design ) Yuhan Luo 10
Co-design sessions: participants Six one-on-one co-design sessions with six registered dietitians (female, age range: 27 to 68) who employ food diaries in their practices. ID Age Practice years Work environment Expertise P1 68 30 Private practice WM, ED, diabetes, GI P2 34 11 Medical center & WM, ED private practice P3 27 2 Eating disorder WM, ED, GI treatment center & private practice P4 43 20 Private practice & WM, ED, diabetes, nutrition during corporate wellness pregnancy, digestive issues P5 34 9 Eating disorder ED, diabetes treatment center P6 60 30 Private practice WM, GI, ED, diabetes, pregnancy, rehabilitative, autoimmune, cardiac issues WM = weight management, ED = eating disorder, GI = gastrointestinal distress Yuhan Luo 11
Co-design sessions: participants ID Experience with existing food diaries P1 MyFitnessPal, Fitbit, paper-based diary P2 Recovery record P3 Recovery Record, Healthie, email, paper- based diary P4 MyFitnessPal, Cronometer, Lose It!, spreadsheet P5 Recovery Record, 24-hour food recall P6 Lose It!, 24-hour food recall, paper-based diary Yuhan Luo 12
Co-design sessions: procedures Pre-design Co-design Pre-study De-briefing activity activity Questionnaire interview Tracker design • Patient • Reflection on Basic • for patient persona tracker design demographics v v personas with creation Discussion on & practice • design widgets Describe • using & sharing experience Thinking-aloud • practice the collected and explain workflow data design rationale Yuhan Luo 13
Design widgets: data formats used in self-tracking tools Text • Image • Audio input • Numeric • Date • Time • Location • Button • Multiple choices • Checklist • Likert scale • External sources (e.g., Fitbit) • Blank widgets • [Kim et al., 2017] Yuhan Luo 14
Data analysis 12 patient personas • 12 paper-based prototypes • Digitizing the prototypes using sketch app o Extracting tracking items, tracking frequency o & timings, data format Audio recordings of the co-design • sessions (70 – 90 minutes / session) Transcribing into text o Generating prominent themes (e.g., design o rationale) using opening coding & affinity diagram (Preece et al., 2015) Prototype created by P2 Yuhan Luo 15
Findings Highlights 16
Patient personas ED-2 D-1 ED-3 P1 P3 P5 WM-1 GI-1 ED-4 WM-2 WM-5 WM-3 P2 P4 P6 ED-1 GI-2 WM-4 D = diabetes WM = weight management ED = eating disorder GI = gastrointestinal distress Yuhan Luo 17
Patient persona examples WM-4 ED-1 ED-3 Symptoms Symptoms Symptoms (P2) (P5) (P4) In good • Bulimia Nervosa • Anorexia Nervosa • health Weight gaining • Over-restrict diet • Over weight • Prediabetes • Over-exercise • Fatty liver • Goals Goals Goals Decrease • Lose weight • Increase calorie • calorie intake Decrease intake • 20 45 50 Increase • Increase food calorie • female female protein intake female variety Drink enough • water ED = eating disorder WM = weight management Yuhan Luo 18
Tailoring Tracker Design • What to track (tracking needs)? • When to track (timing & frequency)? • How to track (data format)? • What to share (sharing preferences)? • How to support tracking (support features)? Yuhan Luo 19
Tailoring Tracker Design • What to track (tracking needs)? • When to track (timing & frequency)? • How to track (data format)? • What to share (sharing preferences)? • How to support tracking (support features)? Yuhan Luo 20
ED-1: what to track? Tracking needs Tracking items ED-1 Symptoms Food Food items, meal type, (P2) Anorexia Nervosa • time Over-restrict diet • Reflection Body image, things to be Over-exercise • proud of, self-care behavior, challenge food, Goals emotion on food Increase calorie • Symptoms ED-behavior intake 20 Increase food • Activity Exercise and duration female variety Physical status N/A Yuhan Luo 21
ED-1: how when once/week once/week eating to track? happens Symptoms ED-1 Anorexia • (P2) Nervosa Over-restrict • whenever diet they occur Over-exercise • once/week Goals Increase • calorie intake 20 Increase food female once/day • variety after exercising
WM-4: what to track? Tracking needs Tracking items Symptoms WM-4 Overweight • (P4) Food Food items, meal type, In good health • time, nutrition facts, portion size, location, water Goals Lose weight Reflection Hunger/fullness level, • Decrease • eating strategy calorie Symptoms N/A Drink enough • 50 water female Activity N/A Physical status N/A Yuhan Luo 23
before WM-4: how to track? eating Symptoms WM-4 Overweight • (P4) In good health • Goals Lose weight • Decrease calorie • Drink enough • 50 water female after once/day eating
Tracking the same item using different format WM-5 (P6) “ A smiley face makes it simple and ED-3 (P5) straightforward.” (P6) Audio-recording may afford patients to record frank thoughts without feeling “ shame about the things they logged ”. (P5) Yuhan Luo 25
Tracking the same item using different format WM-5 (P6) “ One thing I can think of it's like Fitbit, because it also tracks your activity intensity. ” (P6) ED-1 (P2) “ I very much against my clients with eating disorder having any kind of tracking device because it just it's too easy to become obsessed with it.” (P2) Yuhan Luo 26
What to share (sharing preferences)? Patients’ sharing preferences are different depending on The sensitivity of the data • Provider-patient relationship • “ They may not want to share the information due to the feeling of shame and fear of judgment. ” (P5) Sharing preferences can change during treatment Patients may be “ willing to share more with the clinicians as their shame might have decreased throughout the recovery.” (P5) Yuhan Luo 27
Discussion 28
Customizing trackers to generate relevant data Tracker design = patients’ tracking needs + providers’ practice styles • Dietary problems • Symptoms • Practice experiences • Goals • Training backgrounds • Personal preferences Yuhan Luo 29
Supporting provider-patient collaboration Tracker design = patients’ tracking needs + providers’ practice style Providers: revise Patients: adjust sharing tracking items preferences Yuhan Luo 30
Customizing trackers to generate relevant data Tracker design = patients’ tracking needs + providers’ practice style Creating “Tracking Template” Sharing with other providers • Modification & adoption • Yuhan Luo 31
Customizing trackers to generate relevant data OmniTrack: a customizable tracking tool [Kim et al., 2017] Yuhan Luo 32
Limitations and future work Limitation Patient personas may not perfectly capture patients’ lived experiences Future work Involving patients’ into the design process • Field study with providers and patients • Yuhan Luo 33
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