Improving compliance in young diabetics

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‘The Diabetes Book’ is a bachelor thesis from the Royal Danish Academy of Fine Arts – School of Design. It is a tool for young diabetics used during consultation with a health care professional, helping defining and setting goals in order to improve compliance.

By Gertrud Høgh Rasmussen & Maria Søbroe

Diabetes is a chronic disease, demanding a change of lifestyle that has an immense impact on the diagnosed, which is often hard to comprehend. With a rise of diabetics in population world wide, and increased research of medication, we saw a need for working with implementing habits and routines in every day life. The target group for the project was type-1 diabetics, as they are diagnosed at an early age and have the rest of their lives ahead of them, preferably living with the illness as inconvenient as possible.

The project set out to investigate how to improve compliance in young diabetics, starting with conducting interviews and workshops of non-compliant diabetics, exploring their daily life. For the introductory interviews we brought designed dialogue tools, that provided us with an overview and structure of the interview, but also functioned as documentation for later use.

It soon became clear to us that the adolescents didn’t see themselves as diabetics, but young adults with family, friends, school and other interests and activities playing a more important role. Recognizing that they didn’t want the diabetes to control their life, but rather treat it separately, we decided to work with them where the disease was in focus – the consultation situation. We established contact to Steno Diabetes Center to work with health care professionals and to explore their current consultation form, including shortcomings in tools and methods used for communication.

A good dialogue and consultation, proved essential for enhanced compliance, and especially the relationship with the professional crucial. Some of the major challenges the young diabetics faced were implementing information and tasks in daily life, transforming them into routines as well as breaking or altering habits. This problem area was what we chose to work with more specifically.

Through analysis of the existing consultation and several workshops in which we prototyped with diabetics, we saw a need for a dialogue tool that was structuring and opening up the dialogue, while specifying problem areas. There was a need for a visual element to start the dialogue from but also the written, more concrete ‘agreement’ with the professional. We implemented this in a book format – ‘The Diabetes Book’.

‘The Diabetes Book’ is a dialogue tool for young diabetics used during consultation with a health care professional, helping defining and setting goals in order to improve life quality. It consists of a book and a set of association cards. The association cards help opening up for dialogue and supports communicating when difficult. The health care professional and patient articulate a problem area, and defines a goal the diabetic wants to set, writing it down while placing the association card in the book. Jointly, they specify ‘a motivation’, ‘an impediment’ and ‘a help’, placing an illustrating association card, writing it down, as well as agreeing on three specific ways to reach the goal. The patient brings home the book, and may use it to remember what was discussed and agreed. When the young diabetic returns to the following consultation, he brings the book to talk about what has happened since the previous consultation, and what new hurdles and problems might have emerged. If the goal hasn’t been reached, the page is unfolded, goal rephrased and ‘a help’ and ‘an impediment’ redefined.

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The book is a collection of goals, and the format a conscious choice, as it provided a feeling of history and overview of problems overcome. Personalization and taking ownership both the tool and disease was important as well, and therefore we implemented a ‘me’ page, visualizing, with the help of the association cards, answers to questions as ‘my confident is…’, ‘my diabetes annoys me when…’ or ‘to me, a good day is when…’. This helps the diabetic define some aspects to their own life, and provides the professionals, as they are sometimes substituting, with an idea of who their patient is.

Using the Danish DAIM model (Design Anthropological Innovation Model) we have worked in an iterative process with combined design development, workshops, research and evaluation. Through the entire project we’ve involved three diabetic adolescents who have been of great value in both research and prototyping our product. The project has been in collaboration with healthcare professionals from Novo Nordisk A/S diabetic research institution Steno Diabetes Center.

We’d like to thank everyone involved in the project by contributing with valuable insight and feedback.

If you want to know more please contact:

Gertrud Rasmussen at    gertrud.rasmussen (at) gmail.com

Maria Søbroe  at     MASOB (at) edu.kadk.dk

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About Eva Brandt, KADK

Eva Brandt is Professor at The Royal Danish Academy of Fine Arts, Schools of Architecture, Design and Conservation, and holds a Ph.D from 2001. Eva is co-leading the Center for Research in Codesign (CODE). Since September 2014 she has been part of the main faculty for a two year international MA-program in codesign. The main part of her research is about how designers can stage open design processes (design labs) with many participants who both can inquire into existing practices and explore possible futures in common. She also contributes to theorizing about experimental design research driven by programs and experiments. She has been contributing to several books such as Design Spaces (IT Press, 2005), Rehearsing the Future (The Danish Design School Press, 2010), XLAB (The Danish Design School Press, 2011), Facilitating Change – Using Interactive Methods in Organizations, Communities and Networks (Polyteknisk Forlag, 2011), and Routledge International Handbook of Participatory Design (Routledge, 2013). Eva has been chairing the Nordic Design Research Conference in 2013.

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