Examenspresentation av Shivani Ravichandran

Opponent: Nitesh Anil Kumar Nikkam

Supervisors: Ulla Hellstrand Tang, Isabella Scandurra och Stefan Candefjord

Abstract:

INTRODUCTION: Diabetic Foot Ulcer (DFU), is one of the most serious complications of
Diabetes mellitus, as it may result in major problems in the patient’s life, for instance,
amputation, organ damage, and death. One of the main reasons for this complication is
the inability to diagnose the ulcer before it becomes worse. Hence, work is carried out in
the Swedish healthcare region, Västra GötalandsRegionen, (VGR), in an attempt to,
assess the risk (according to a risk scale) of the patient with diabetes to develop DFU. This
assessment will be accomplished via an e-health tool, a mobile application to be used by
district nurses when consulting a patient for a foot examination. Today the foot examination
has no digital support, and there is a need for a smooth mobile tool that can help
document the examination “foot-side”, when and where the examination is carried out.
AIM: The aims were both to create and test a demonstrator of a digitalized process that
will support healthcare professionals to make a structured foot examination in patients with
diabetes.
METHODS AND MATERIALS: The demonstrator for the application was iteratively
designed using a user-centered development approach and software, FIGMA. The
demonstrator’s efficiency and effectiveness were measured by performing an onsite
usability test in VGR by nine healthcare professionals. In parallel with the usability test, a
user satisfaction questionnaire, called System Usability Scale, (SUS), was used twice.
First to measure the test participants’ expectations before using the demonstrator, and
later to measure their satisfaction with the usability of the demonstrator. Answers were
gathered regarding the test participants’ current experience of working with foot
examinations, with or without digital support, as well as suggestions for improvements to
the design.
RESULTS: Based on national clinical guidelines, regarding how to identify risk factors to
develop DFU, an eHealth demonstrator was conceptually designed and validated. The
demonstrator contained three modules: education, examination, and documentation. The
demonstrator was designed in FIGMA, and formatively assessed on tablets by healthcare
professionals, simulating an ordinary foot examination. Analyzing the individual results, 4
of 9 participants assessed, their satisfaction with the demonstrator was higher than their
expectations. For both the expectancy score and the satisfaction score, mean (77;69) and
median (77.5;70) values are within the “Acceptability ranges” (65-75; 75-100), when
compared to SUS scores in general.
CONCLUSION: The study investigated the potential and benefit of applying digital support
to be used by healthcare professionals when performing a structured foot examination.
The study also investigated the benefits of promoting and disseminating such knowledge
in a clinical context through the realization of a demonstrator, which was assessed by
potential future users. In summary, 1) By testing a demonstrator via usability tests and
questionnaires, we learned more about the digital support an app could provide in a real
world setting and also, preferences required in future designs, as expressed by the test
participants. 2) A novel, “dual use” of the SUS questionnaire was created. By comparing
the users’ expectations regarding the use of the demonstrator with their satisfaction of
using the demonstrator, similarities or differences are revealed. Although there is a need
for further methods’ research of using SUS in a pre-test situation to gather expectations,
this contribution to research is a novel take on one of the most well known and spread
usability questionnaires.
The HCPs performing the tests also suggested improvements in the design of the
demonstrator which will be considered for future development.

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