Personalised Micro-Intervention Technology for Diabetes Self-Management

In this dissertation we investigate how personalised micro-intervention technology may be designed for use in Type 2 Diabetes Mellitus (T2DM) self-management. Micro-interventions are short momentary interventions aiming to have an immediate impact on targets. A proposed advantage of these interventions is that these reduce barriers associated with meaningful engagement by their short-term nature. However, micro-intervention technology is largely in its infancy and several unanswered questions remain regarding how the technology should be used and supported. Moreover, no unified terminology exists for what micro-interventions are nor what structures or types of systems facilitate their delivery. Our investigation of personalised micro-intervention technology for T2DM was carried out from three angles, firstly by looking at mobile health (mHealth) technology for diabetes, secondly by looking at the practical real-world use of micro-interventions and thirdly by exploring the theoretical constructs of what micro-interventions are, what components they are comprised of and what structures facilitate their delivery.
We initially, investigated through two studies what features or “components” of mHealth technology are desirable and useful for diabetes self-management. In our first study we formally looked at the literature on T2DM mHealth exploring and discussing a multitude of reported application components, barriers, facilitators, attrition rates and effects. However, we also uncovered significant gaps in reporting of attrition and rationale making it difficult to gauge which components and designs are truly useful for persons with diabetes. Our second study aimed to bridge this gap by engaging in a co-creation process with end-users and stakeholders. This co-creation process resulted in two user experience prototypes namely: an activity-based continuous glucose monitoring application and an online guide to diabetes. The study additionally explored the rationale and user experience over time for the created designs as well as exploring a number of diabetes thematic insights.
To generate knowledge about the real-world use of micro-interventions we investigated the use of ”Episodic Future Thinking” as digital micro-interventions delivered through mHealth in two studies. Episodic Future Thinking is an intervention aiming to influence everyday decisions, promoting choices with long term benefits in this context health. The first of these studies focused on the design, implementation, and evaluation of a simple mHealth application delivering three micro-interventions. Our results showed that the use of episodic future thinking micro-interventions was feasible, but not always preferable to users. Our second study investigated the effectiveness of the developed micro-interventions and the mHealth technology, moreover aiming to explore the effects and user perceptions of two kinds of episodic future thinking. Results show that both kinds of episodic future thinking micro-interventions were effective but also that the version explicitly including goals was slight more effective while also providing additional benefits.
Finally, we returned to the more theoretical question of what a micro-intervention is, what components these consist of and what structures support their delivery. We developed the ”Design for Micro-Intervention Software Technology” (D-MIST) framework based on a systematic review of the available literature on micro-interventions, prior definitions of the term and our own insights from the aforementioned studies. The framework formalises the role of the system in delivering micro-interventions, how these may be combined to create narratives and what exactly a micro-intervention is. The D-MIST framework provides researchers and designers with a unified way of understanding, classifying, designing, and evaluating micro-interventions as well as the systems that deliver them. Finally, we explore how this framework adds to our knowledge of how personalised micro-intervention technology can be created.