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Honours Project Report
E-Health Diabetes Self Management System
by Dalton Jarryd Jacobs
Supervisor:
Dr Hanh Le
Co-supervisor:
Prof. Edwin Blake
Category Min Max Chosen
1 Requirement Analysis and Design 0 20 20
2 Theoretical Analysis 0 25 0
3 Experiment Design and Execution 0 20 0
4 System Development and Implementation 0 15 10
5 Results, Findings and Conclusion 10 20 20
6 Aim Formulation and Background Work 10 15 10
7 Quality of Report Writing and Presentation 10 10
8 Adherence to Project Proposal and Quality of Deliverables 10 10
9 Overall General Project Evaluation 0 10 0
Total marks 80 80
Department of Computer Science
University of Cape Town
2011
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Abstract
The E-health project focuses on developing a system which aims to assist in better self-management of
diabetes. The proposed system is divided into three sections: the website interface, the Facebook
application and the mobile application. This report focuses on the website interface and the back-end
system. Through the use of questionnaires and consultations with diabetes experts the user requirements
for the system were obtained. Based on the requirements deducted from the consultations with diabetes
experts and questionnaire a low fidelity prototype was developed to be tested by users. Feedback
obtained from the low fidelity prototype was proved to be useful as it refined the features of the system.
Thereafter a high fidelity prototype was developed through the feedback from low fidelity and was tested
by users again. Based on the feedback derived from the high fidelity prototype a fully functional system
was designed and implemented. This system was then tested in a five day pilot test and found to have met
the user requirements and expectations. Feedback from users was that the system was easily accessible,
easy to use and features proved to be useful in the management of diabetes.
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Acknowledgements
Thank you to Prof. Michael Lambert, Emily Ryan, Dr Ian Ross and Carol Hendricks in helping to make
the system more accurate. Also thank you to Dr Hanh Le and Prof Edwin Blake for the guidance and
support.
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Table of Contents
Abstract ........................................................................................................................................................ ii
Acknowledgements ..................................................................................................................................... iii
List of Tables and Figures ........................................................................................................................... vi
1. Introduction ...........................................................................................................................................1
1.1. Project Proposed ...........................................................................................................................1
1.2. Structure of Report ........................................................................................................................1
2. Background Chapter .............................................................................................................................2
2.1. Introduction ...................................................................................................................................2
2.2. Diabetes.........................................................................................................................................2
2.3. Diabetes and Self-Management ....................................................................................................3
2.4. Social Networking Today .............................................................................................................3
2.5. Social Networks for E-Health .......................................................................................................3
2.6. Services provided by E-Health Social Networking Sites ..............................................................3
2.6.1. Emotional support and Information sharing .........................................................................4
2.6.2. Q&A with Physicians............................................................................................................4
2.6.3. Quantified self-tracking ........................................................................................................5
2.6.4. Clinical Trial Access .............................................................................................................5
2.7. Conclusion ....................................................................................................................................6
3. Analysis Chapter ...................................................................................................................................7
3.1. Understanding Diabetics ...............................................................................................................7
3.1.1. Doctors ..................................................................................................................................7
3.1.2. Social Support Group Leaders ..............................................................................................8
3.1.3. Dietician ................................................................................................................................8
3.2. Questionnaire Results ...................................................................................................................8
3.3. Conclusion ..................................................................................................................................11
4. Design Chapter ....................................................................................................................................13
4.1. Low Fidelity Design Iteration .....................................................................................................13
4.1.1. Design .................................................................................................................................13
4.1.2. Evaluation and Findings ......................................................................................................16
4.2. High Fidelity Design Iteration ....................................................................................................17
4.2.1. Design .................................................................................................................................17
4.2.2. Evaluation and Findings ......................................................................................................18
4.3. Database Design ..........................................................................................................................21
4.4. Server Design ..............................................................................................................................22
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4.5. System Requirements ..................................................................................................................22
4.5.1. Hardware Requirements ......................................................................................................22
4.5.2. Software Requirements .......................................................................................................22
4.6. Conclusion ..................................................................................................................................23
5. Implementation Chapter ......................................................................................................................24
5.1. Final Prototype Design Iteration .................................................................................................24
5.1.1. Login and User Registration ...............................................................................................24
5.1.2. Home ...................................................................................................................................25
5.1.3. My Profile ...........................................................................................................................25
5.1.4. Calorie Calculator ...............................................................................................................25
5.1.5. Record Glucose ...................................................................................................................27
5.1.6. Reminders ...........................................................................................................................28
5.1.7. Contact Us ...........................................................................................................................28
5.2. Conclusion ..................................................................................................................................28
6. Testing, Evaluation and Findings ........................................................................................................29
6.1. Pilot Test .....................................................................................................................................29
6.2. Findings.......................................................................................................................................29
6.3. Conclusion ..................................................................................................................................30
7. Conclusion and Future Work ..............................................................................................................31
7.1. Future Work ................................................................................................................................31
8. References ...........................................................................................................................................32
9. Appendices ..........................................................................................................................................34
9.1. Appendix A: Questionnaire ........................................................................................................34
9.2. Appendix B: Evaluation Form for Final E-Health Prototype .....................................................43
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List of Tables and Figures
Figure 2-1: Example of Emotional Support and Information Sharing ..........................................................4
Figure 2-2: Example of Viewing Physician Credentials ...............................................................................5
Figure 2-3: Example of Quantified self-tracking ..........................................................................................5
Figure 3-1: Age of Questionnaire Participants (left-Online Group & right-Support Group) .......................9
Figure 3-2: Type of Diabetes of Questionnaire Participants (left-Online Group & right-Support Group) ...9
Figure 3-3: Internet Access of Questionnaire Participants (left-Online Group & right-Support Group) ...10
3-4: The amount of Online Participants in support group...........................................................................10
Figure 3-5: Preference of a Cellphone or PC/Laptop of Questionnaire Participants ..................................11
Figure 4-1: Layout of Website ....................................................................................................................13
Figure 4-2: Home Page for Paper Prototype ...............................................................................................14
Figure 4-3: My Profile Page for Paper Prototype ......................................................................................14
Figure 4-4: Calorie Calculator Page for Paper Prototype ...........................................................................15
Figure 4-5: Record Glucose Page for Paper Prototype ...............................................................................15
Figure 4-6: Reminders Page for Paper Prototype .......................................................................................16
Figure 4-7: Layout of Website (After Low Fidelity Evaluation) ................................................................17
Figure 4-8: Login Page for E-Health Website ............................................................................................18
Figure 4-9: Profile Page for Website ..........................................................................................................18
Figure 4-10: Home page for Website ..........................................................................................................19
Figure 4-11: Calorie Calculator page for Website ......................................................................................19
Figure 4-12: Add Calories Consumed and Calories Burned foor Website .................................................20
Figure 4-13: Record Glucose and Graph page for Website ........................................................................20
Figure 4-14: Database Design .....................................................................................................................21
Figure 5-1: Login/Registration page for Final Prototype ............................................................................24
Figure 5-2: Home page for Final Prototype ................................................................................................25
Figure 5-3: My Profile page for Final Prototype ........................................................................................25
Figure 5-4: Calorie Calculator page for Final Prototype ............................................................................26
Figure 5-5: Calorie Consumed page for Final Prototype ............................................................................26
Figure 5-6: Calorie Burned page for Final Prototype .................................................................................27
Figure 5-7: Record Glucose page for Final Prototype ................................................................................27
Figure 5-8: Graph of Record Glucose for Final Prototype .........................................................................27
Figure 5-9: Reminders page for Final Prototype.........................................................................................28
Figure 5-10: Contact Us page for Final Prototype ......................................................................................28
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1. Introduction
Often people who are diagnosed with diabetes need to make major changes to their lifestyle. This
is not easily done as diabetics can be de-motivated by the lack of social support. Research shows
that there aren‟t any publicly available E-health applications or systems that could assist in the
self management of diabetes in South Africa. On the other hand there are commercial available
products which have to be purchased and are not affordable by the average person. Additionally,
there are no publicly available online social support structures for diabetics in South Africa and
patients prefer to remain anonymous. In this project we hope to develop a system that is
accessible and available at low cost. The system will aim to assist in the self management of
diabetes, method of record and data keeping, which is essential part of a diabetic‟s daily life.
1.1. Project Proposed
We proposed to develop a system which assists users in self management of diabetes. This will be
accomplished through a User Centred Design process which requires continuous consultations
with users in design decisions throughout the development process. This project will ensure that
users are involved with research and testing process of the diabetes self management software to a
great extent. The proposed system will be built on three different platforms by each of the
different team members. The workload will be divided as follows:
1. Diabetes Self Management System on a Website
2. Diabetes Self Management System on a Facebook Application
3. Diabetes Self Management System on a Mobile Application
This report will focus on the online website. The website, Facebook application and mobile
application will be connected to a central database to store patient‟s data. The database will serve
as a backbone to the system. Each platform will be able to communicate with the central server
and users will be able to access any of the above three platforms to assist in the management of
diabetes depending on their requirements and resources available to them.
1.2. Structure of Report
The report will firstly cover the background research which was previously completed. An
analysis of user requirements through an experts perspective. The system design is discussed and
then followed by the implementation of the project. The implemented system will then be tested
and reviewed for improvements. This report will then conclude with the findings.
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2. Background Chapter
Diabetes self-management and social healthcare networks are the major research topics. This
section will focus on the background research covered for this honours project.
2.1. Introduction
Previous research has shown that diabetes is increasing at an alarming rate in society due to social
factors such as obesity and the lack of exercise [Demand Media 2011]. Diabetes is one of the
better known chronic illnesses which can have debilitating effects on those affected both mentally
and physically [Demand Media 2011]. As a chronic disease marked by high sugar levels in the
blood, the body‟s inability to either produce or respond to insulin often results in health
complications for the individual concerned if the correct treatment is not administered [A.D.A.M.
2011a;Swan 2009]. For some individuals limited access to healthcare and information on the
disease could lead to more severe consequences such as paralysis or blindness [Demand Media
2011]. Individuals affected by both a chronic illness and a disability may struggle to find and
maintain work placing a financial load on their families [Demand Media 2011]. Systems have
been developed to ease the lifestyle of a diabetic individual. The Freestyle Navigator helps with
the monitoring of glucose levels by using a special strip to read the sugar levels in the blood
[Heller and Feldman 2010]. Other systems act to manage the disease such as the Diabetes Pilot
which helps to record measurements, tracks dietary information in food, helps see trends through
a graph and sends data for inspection to a medical physician for further analysis [Digital Altitudes
2010]. Sometimes family support and management systems are not enough. Patients often look to
the internet to find other people with similar illnesses to aid and advise them where their medical
condition is concerned [Greene et al. 2010,;Pearson 2010,Swan 2009]. Patients like these rely on
online social media such as Facebook, Twitter, TuDiabetes and PatientsLikeMe to find social
support [Swan 2009].The social networking sites are powerful and cost effective communication
tools [Hawn 2009]. This section critically analyses the available information on the effect of
social networks and E-health today. Several E-health social networking sites such as
PatientsLikeMe, CureTogether and MedHelp will be used to present an example of the various
services provided.
2.2. Diabetes
Diabetes can be better understood through how food is broken down and used by the body for
energy [A.D.A.M. 2011a; Medilexicon International Ltd 2011]. A sugar called glucose enters the
bloodstream and glucose is a source of fuel for the body [A.D.A.M. 2011a; Medilexicon
International Ltd 2011]. Insulin produced by the pancreas and its role is to move glucose from the
bloodstream into fat, muscle and liver cells, where ever the body needs fuel [A.D.A.M. 2011a].
People with diabetes have high blood sugar because their body can move the glucose into the
liver, fat and muscle cells to be stored for energy [A.D.A.M. 2011a]. This is due to their pancreas
does not produce or respond to insulin [Medilexicon International Ltd 2011]. Diabetes is
treatable, however Type 1 and Type 2 last a lifetime [Medilexicon International Ltd 2011]. Type
1 diabetes can occur at any age, but it is most often in children or young adults [A.D.A.M. 2011a;
A.D.A.M. 2011b]. This occurs when the body does not produce insulin at all. Type 2 diabetes is
the most common form and occurs usually slowly overtime. The body does not produce enough
insulin or the body is not using the insulin correctly [A.D.A.M. 2011a; A.D.A.M. 2011c].
Diabetes can be treated through monitor your glucose levels, diet, exercise, weight control and
medication to treat diabetes [Medilexicon International Ltd 2011, A.D.A.M. 2011b, A.D.A.M.
3
2011c].There are early symptoms of diabetes which may include hunger, increased thirst,
increased urination, infections that heal slowly, fatigue, blurred vision and weight loss[A.D.A.M.
2011a;Medilexicon International Ltd 2011]. The main goal of diabetes treatment is to control the
glucose levels to avoid further complications.
2.3. Diabetes and Self-Management
Minority Americans are at increased risk of contracting diabetes which could lead to organ
failure and need a transplant [Carter et al. 2011]. Patients who are diagnosed with diabetes often
have to make lifestyle changes in their daily routines [Heinrich 2011]. Most diabetics are treated
at health clinics with little self-management knowledge and this can be quite expensive [Carter et
al. 2011]. Self-management is an essential tool that can limit the impact of a chronic illness to a
patient [Heinrich 2011]. Research has shown that knowledge, preparation for consultations, active
patient participation during consultations, lifestyle changes, and patients‟ involvement in setting
goals which are essential for self-management [Heinrich 2011; Williams et al. 2004; Williams et
al. 2004; Clark et al. 2010; Heisler et al. 2002 ]. In providing an e-health self-management system
that assists with recording of glucose levels, setting reminders/notifications and record diet and
exercise routines can help to control the diabetes.
2.4. Social Networking Today
Social networking sites have become very popular over the past few years and have expanded at a
rapid rate since then. The Web has become more accessible through the advancement of cell
phone technology making it increasingly easier for people from all backgrounds to connect with
the online social media network [Shachak 2011]. Social networking sites like Facebook draws its
popularity through the ability of the user to create personalized profiles, to find long lost friends,
to join community interest groups and also to communicate with peers all over the world [Zywica
2008]. Many of these social networking sites have become a tool that brings people with similar
interests together to interact and in some cases seek medical advice from one another [Diabetic
Live 2011, Swan 2009]. As such websites such as Facebook, Twitter and Wikipedia can used in a
more health-specific manner to target health professionals and the public, is creating new, cost
effective ways to embed a powerful tool into a healthcare system [Shachak 2011].
2.5. Social Networks for E-Health
E-health is characterized as “Internet medicine” referring to healthcare services and information
delivered through the internet. Social networking sites which have adopted a focus on health
provide a cost effective way for patients to receive information and social support on their
condition [Shachak 2011]. Most electronic healthcare records are made to support a one-to-one
interaction between the patient, healthcare professionals and administrators [Shachak 2011]. E-
health social networking sites provide many-to-one, one-to-many or many-to-many
communication or interaction between parties essentially extending the patients participation in
their own health decisions and management as well as provide useful web tools for diagnosis help
and research on medication [Pearson 2010; Shachak 2011].
2.6. Services provided by E-Health Social Networking Sites
A key role of an E-health social network is the potential to find others in similar situations and
share information about treatments, symptoms and conditions [Swan 2009]. This will help
4
patients to make healthcare decisions through shared collective learning and experiences [Swan
2009]. A website that provides some of these services is PatientsLikeMe which allows the client
to monitor their symptoms and medication routines over time [Pearson 2010, Swan 2009]. The
four main types of services that an e-health social network provides are clinical trial access,
emotional support and information sharing, quantified self-tracking and Q&A with a professional
physician [Swan 2009].Social networking sites such as CureTogether, PatientsLikeMe and
MedHelp provide services to patients covering a variety of medical conditions [Swan 2009]. For
example PatiensLikeMe covers 16 medical conditions and provide services such as emotional
support and information sharing, quantified self-tracking and clinical trial access [Swan 2009].
2.6.1. Emotional support and Information sharing
The most basic service provided by most healthcare social networks is emotional support and
information sharing [Swan 2009]. CureTogether allows patients to anonymously compare and
track conditions with one another focusing more on information sharing than emotional support
[DHILLION et al. 2011; Neal 2010]. Conversely, members of PatientsLikeMe offer one another
support based on their own experience and advise each other on medical issues and how to
improve day-to-day life [Frost and Massagli 2009]. Websites such as PatientsLike and
CureTogether offer emotional support at an implicit or an explicit level [Swan 2009]. Emotional
support is received implicitly through the observation of other patient‟s conditions and explicitly
(Figure 2-1) through user interactions where members of the site can reply to forums, send public
or private messages, give advice and give a social greeting [Swan 2009].
Figure 2-1: Example of Emotional Support and Information Sharing
2.6.2. Q&A with Physicians
A service that a few e-health social networks provide is the ability to ask questions to a medical
expert [Swan 2009]. A site like Facebook is not a place to seek professional advice due to the
absence of forums administrated by trained professionals. A well known social networking site
that provides this service is MedHelp which connects regular people with medical experts to give
patients aid and support [Yang 2010]. As an interactive social network as well as an informative
healthcare forum, patients are allowed to view a physician‟s credentials (Figure 2-2) before
posing a question to anyone [Swan 2009; Yang 2010]. One of the draw backs of this service is
that many of the doctors are only willing to answer questions once paid [Swan 2009].
5
Figure 2-2: Example of Viewing Physician Credentials
2.6.3. Quantified self-tracking
Another service that healthcare social networks provide is the ability to allow the user to manage
and track their health condition [Pearson 2010]. CureTogether, MedHelp and PatientsLikeMe
provide a quantified self-tracking option [Pearson 2010; Swan 2009]. This functionality gives
patients easy to use data entry screens for condition, symptom, treatment and other biological
information [Pearson 2010; Swan 2009]. The information can be seen on a graphical display and
can be viewed by individual or by groups [Pearson 2010]. This service helps patients to view their
status in an analytical format [Pearson 2010]. The website PatientsLikeMe allows the user to have
a statistical view on their condition and track their prescription drug usage. Patients who have a
chronic disease like diabetes can use this service to monitor their glucose levels and will be able
to evaluate a trend in the graph to decide when to increase or decrease sugar levels in the blood
[Pearson 2010]. An example of a graphical view on the patient‟s illness progressions, prescription
drugs and symptom tracking is shown in Figure 2-3 [Brownstein et al. 2009].
Figure 2-3: Example of Quantified self-tracking
2.6.4. Clinical Trial Access
Many patients who use PatientsLikeMe are alerted if their medical information is needed for
clinical trials [Pearson 2010]. The combination of online health tracking and clinical trials allows
6
patients to make their experience feedback, including response to drugs, available as a public
resource [Swan 2009]. Clinical trials are more efficient through the availability of large online
searchable database of patient‟s health history and condition information [Pearson 2010]. This
data can lead to new findings and give a better understanding to conditions [Swan 2009].The
information gathered from PatientsLikeMe can be sold to pharmaceutical companies, universities
and research labs which will allow research facilities find a cure faster [Swan 2009].
Based on the findings, an efficient and cost-effective site can be created specifically for diabetics.
Unlike the E-health social networks mentioned, this putative site could provide these services and
more. On the information gathered, Q&A with a medical expert can be costly, however through
collaborating with a research institution by providing them with subjects for clinical trials in
exchange for free medical advice. Quantified self-tracking is useful to diabetic patients through
the fact the information is able to be assessed and can be a useful tool for monitoring trends as in
PatientsLikeMe [Swan 2009]. The main focus of the services is emotional support and
information sharing which is the core idea for providing an e-health social network. By enforcing
these services can provide diabetics with all the resources to achieve good health.
2.7. Conclusion
Diabetic individuals who do not have access to proper treatment or information systems often
experience an overall reduction in their quality of life. The research conducted on the e-health
social networks was to provide a more efficient framework upon which a website/database could
be developed for people with diabetes. There are a number of commercial online services
available that can aid in self-management but there are few cost effective systems that assist in a
patients‟ daily progress which may include diet and exercise routines. Services like clinical trials,
Q&A with physicians, quantified self-tracking, emotional support and information sharing need to
become more accessible and affordable to most people suffering from diabetes. A mobile system
that provides these services has not yet been created as such presents an opportunity to many
possibilities. The E-health social network proposed will give diabetic patients the ability to
manage and seek advice through a smart phone to attain good health. This proposed low-cost
system can be valuable as it can encourage patients to interact with other patients and online
medical professionals.
7
3. Analysis Chapter
This chapter analyses the requirements of self management of diabetes through consultations with
experts. As a non-diabetic, knowledge of what the system requires is very little. Therefore there
is a need to consult medical professionals and support group leaders are to help understand the
requirements of potential users. Thereafter a decision was made that a paper and online
questionnaires are required to know what the diabetics would want from the system. In order to
acquire the initial requirements of the system, a questionnaire was distributed at social group
gatherings and posted on Diabetes South Africa (DSA) Facebook page. Other diabetes Facebook
groups were asked to post a link of our online questionnaire but were not successful as Facebook
group administrators did not allow it. Based on the results of the questionnaire and interviews
with experts a prototype will be developed.
3.1. Understanding Diabetics
As a non-diabetic, consultations with medical professionals and diabetic support group leaders
would help to find the requirements needed to manage diabetes. Meeting were arranged with
diabetologists and support group leaders from DSA. This was essential to understand diabetics
before the development of the system.
3.1.1. Doctors
Before the interview with the doctors, a questionnaire was compiled by the group and utilized to
interview doctors in order get a better understanding of this chronic disease. Our first interview
was with Dr Ian Ross, Endocrinologist consultant at Groote Schuur Hospital, who was very
enthusiastic in helping to develop a system that assists with managing a patient‟s diabetes. The
doctor‟s patients are at an age range of 22-80 years with a norm of 45 years and patients are in
combination of Type 1 and Type 2 diabetes. Most of the doctor‟s patients visit once a month and
keeps in contact with them either face to face or via telephone. The doctor usually expects
patients to keep a diary or record of blood glucose level readings, diet, insulin intake, physical
exercise and to check feet to ensure they are dry in order to self-manage diabetes. However, the
challenges the doctor faces when it comes to analyzing patients' progress are:
Poor monitoring of glucose levels and diet.
Difficulty in checking if patients comply with medication, insulin intake, exercise and
dietary requirements.
Ensuring that patients are making appropriate adjustments to their self-management.
Failure to act on their glucose level readungs, if patients are above or below normal sugar
levels.
The final comments of Dr Ian Ross were:
Most of the patients are poor and should not spend money from a research point of view
Diabetes self-management is complicated as a whole.
It may be necessary to work with a dietician to get advice on how to maintain a daily
calorie intake of a patient.
A solution should include general reminders e.g. check glucose levels, when to take
insulin etc.
A suggestion of a pedometer could be used to monitor calories burned through walking.
8
In allowing patients to socialise (e.g. forum, chat) with each other can be dangerous to a
patient‟s health i.e. A diabetic A tells diabetic B to increase insulin intake which can be
harmful to diabetic B.
We approach and called other diabetologists in Cape Town, but unfortunately the medical experts
were unavailable at the time.
3.1.2. Social Support Group Leaders
A decision was made that we should call Diabetes South Africa (DSA) for assistance with the
project and to help find diabetics within Cape Town. A call was made to DSA and we were given
the details of a support group leader in Mitchells Plain. The support group leader was contacted
and visited for an interview. It was found that the doctor and the support group leader had similar
views on the project. We were given a pamphlet on diabetes and what a diabetic should do to
manage their illness. This pamphlet had a lot of information on diabetes and it also gave advice
for diabetics such as have a healthy eating plan, exercise regularly, take appropriate medication
and test blood glucose level. We were also given the names of a few other support group leaders
in Cape Town. Support group leaders were approached and we were given dates on when their
groups met so that we could distribute questionnaires to diabetics which will be discussed later in
section 3.2.
3.1.3. Dietician
As advised by the doctor, a dietician could be helpful in providing advice for calorie intake for a
diabetic‟s diet. A dietician named, Emily Ryan, was interviewed and we were given calculations
on how to determine the amount of calories needed per day to maintain, lose or gain weight. We
were also given a diet plan of a recent diabetic patient to provide us with an idea of what diabetics
should eat. It was recommended that each person should eat 50% carbohydrates, 20 % protein and
30 % fat per day to meet daily requirements. The dietician recommended two books which helped
to determine the amount of protein, fat, carbohydrates and calories for each portion of food for the
diet plan given.
3.2. Questionnaire Results
The questionnaire was handed to two groups, an online group and a support group. It was posted
on various Facebook diabetes groups and also given to diabetics at support group meetings
situated in Mitchells Plain. An example of the questionnaire can be found in the appendix. Most
of the participants in the support groups felt it was easier to talk to someone rather than simply
filling in the questionnaire. Participants were informed that information participants give would
be highly confidential and anonymous. Each questionnaire gives a summary of the project and is
indicated at the top, the information gathered was used for research purposes. Participants could
indicate if they are willing to participate in the design, development and testing process of the
system. Those who indicated “yes” and filled in their contact details were later contacted to
participate in the testing process.
We gathered 100 completed questionnaires, 44 from the online group and 56 from the support
group. The data from questionnaires were analysed using Google forms. The following
questionnaire results were used to show a breakdown of the most significant results found and
design decisions made upon them.
9
Questionnaire Results Observed and Design Implications
Figure 3-1 below shows the age of participants which falls in a particular range. On the right of
Figure 3-1 most of the support group participants are above 50 years and on the left of Figure 3-1
are the online participants that are in a diverse range of age groups which were mostly below 30
years. We would like to design for the ages from 20-50 years as most of the diabetics fall under
this age group.
Questionnaire Results Observed and Design Implications
Figure 3-2 below gives the type of diabetes of questionnaire participants. On the left of Figure 3-2
are the online group participants and on the right are the support group participants. 39% and 41%
of the online participants have Type 1 and Type 2 diabetes respectively. 11% and 68% of the
support group participants have Type 1 and Type 2 diabetes respectively. 20% of the online
participants and 21% of support group participants did not know their type of diabetes. We would
like to design a system to cater for both Type 1 and Type 2 diabetes.
Questionnaire Results Observed and Design Implications
Questionnaire participants were asked what tasks participants would like to perform and the
results were record glucose levels, view glucose level trends, monitor diet, monitor physical
exercise and a reminder/notification service. Glucose levels, diet, exercise and reminders are the
main tasks that participants would like to perform.
Figure 3-1: Age of Questionnaire Participants (left-Online Group & right-Support Group)
Figure 3-2: Type of Diabetes of Questionnaire Participants (left-Online Group & right-Support Group)
10
Questionnaire Results Observed and Design Implications
Participants were also asked with whom participants discuss their diabetes i.e. glucose levels, diet
and exercise and the results were doctor, family and other diabetics. As Dr. Ian Ross said it could
be harmful to allow patients to contact one another, therefore the design will not allow users to
communicate. However, the system can be designed for doctors to give advice to diabetics.
Questionnaire Results Observed and Design Implications
In the results of Figure 3-3 above illustrates the accessibility to the internet of questionnaire
participants. On the left of Figure 3-3 shows the accessibility of online participants and on the
right of Figure 3-3 shows the accessibility of support group participants.100% of online
participants and 33% of support group participants had access to the internet. The online
participants do not need extra cash to access website whereas most of the support group would
need to use extra money to get internet access.
Questionnaire Results Observed and Design Implications
A significant result was found about 80% of the online participants do not belong to support
group and seeks assistance on the internet instead as it is a broader communication channel. A
system can be designed help users get medical support through the web.
Figure 3-3: Internet Access of Questionnaire Participants (left-Online Group & right-Support Group)
3-4: The amount of Online Participants in support group
11
Questionnaire Results Observed and Design Implications
Questionnaire participants were asked about their preference on assistance with their diabetes
self-management. In Figure 3-5 below shows the results of their preference. The top of Figure 3-5
displays the results of the online participants and the bottom of Figure 3-5 displays the results of
the support group participants. 84% of online participants would like to use a PC or laptop to
manage their diabetes whereas 39% of online participants would like to use a cellphone. Only 8%
of the support group participants wanted to use a PC/Laptop, 19% wanted to use a Cellphone and
77% did not want either to manage their diabetes. We would like to design a system that is
accessible through a website, mobile application and a Facebook application.
Figure 3-5: Preference of a Cellphone or PC/Laptop of Questionnaire Participants
(top-Online Group & bottom-Support Group)
At the end of each questionnaire participants were asked whether the participants were willing to
participate in testing a prototype in the next 5 months. 43% of online participants and 25% of
support group participants said they would be interested in testing a prototype of the system. This
result shows there is potential for the system to have a website interface.
3.3. Conclusion
Through a medical professional perspective, allowing diabetic patients to communicate and help
each other through social networking can be detrimental. To avoid the risk of harming users we
decided to not allow users to give advice by means of a chat or forum. Through the consultations
with a doctor, support group leaders, dietician and questionnaires the following features were
derived for the system:
Record of Glucose Levels
Provide a reminders service
Diet control
Exercise plan
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Monitor calorie intake
Record of Insulin intake
Once the questionnaire and interviews with experts were analysed, it was time to design the
system with the above features in mind. We decided to use the online group participants for the
design and testing process as most of the support group participants did not have access to the
internet and the technology to help in managing their illness. The next chapter will discuss the
design process in the development of the system.
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4. Design Chapter
This chapter will outline and explain in great detail the steps initially taken to design the Diabetes
E-Health Self-Management Web Interface and the system requirements for the back-end. This
was required since the project was to follow an iterative design process. As well as utilize some
principles from a User Centred Design which requires continuous consultations with users in
design decisions throughout the development process. The goal of user-centred design process is
make the system user friendly and to help develop the system features that diabetics require.
The basic outline of the iterative design process is as follows:
1. Complete an initial interface design
2. Present the design to several test users
3. Note any problems had by the test users
4. Refine interface to account for/fix the problems
5. Repeat steps 2-4 until user interface problems are resolved
4.1. Low Fidelity Design Iteration
Based on the results of questionnaire and consultations with diabetes experts, a paper prototype
was created. The purpose of the low fidelity prototype is to give the user a good sense of what the
system can do and get feedback on the design. The prototype was tested by five diabetics and
problems were then jotted down to make improvements for the high fidelity prototype. Each
participant tested the website, the Facebook application and the mobile application. The paper
prototype was created on Microsoft Word and printed for the users to test. The goal of the low
fidelity design is to quickly create a prototype for testing.
4.1.1. Design
The website interface will serve as an independent platform to help assist with management of
diabetes. Through the analysis of the questionnaire the structure of website was developed which
is shown in Figure 4-1 gives the general layout of the website. The user will first have to register
with a username and password. After registration the users will need to plug in the details some
personal information to allow features to work. The following are brief descriptions of the initial
design of the web interface features.
Figure 4-1: Layout of Website
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Home
The Home page is the first page which pops up when the user logs into the system. This webpage
gives the user a breakdown of how much calories is need to maintain, lose or gain weight. The
user can also add calories consumed and calories burned throughout the day. This page also
allows the user to monitor their diet and exercise. If the user adds calories consumed, the user can
either enter the amount of calories or select a meal and entering the portion sizes. If the user adds
calories burnt, the user can either enter the amount of calories or the pedometer reading. Figure
4-2 below is the home page of the paper prototype.
My Profile
The Profile page is the first page which pops up when the user registers for the first time. This
webpage allows the user to fill in their personal details and can be updated to the user‟s discretion.
These details will be used by other features to function properly. If the user wants to update the
profile the user will need to click save button. Error! Reference source not found. below is the
y Profile page of the paper prototype.
Figure 4-3: My Profile Page for Paper Prototype
Figure 4-2: Home Page for Paper Prototype
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Calorie Calculator
The Calorie Calculator allows the user to determine the amount of calories needed to gain, lose or
maintain weight. The main goal of this webpage is to allow the user to calculate the amount of
calories needed. The user needs to fill in their weight, height in their profile or simply fill it in on
this page. The user also needs to fill in how active they are as well as fill in whether they want to
maintain, lose or gain weight. Once the calculate button is clicked, a message on the amount of
calories needed to gain, lose or maintain weight will pop up which is shown in Figure 4-4.
Record Glucose
This feature will allow the user to monitor their glucose levels each day, view a graph of the
trends of the user‟s glucose levels and view the seven recent entries of glucose levels. The user
will need to fill in the appropriate date and glucose level. If the user clicks on submit the entry
will pop up in the glucose history. If the user clicks “View Graph” a graph of the user‟s glucose
levels pops up and the user is given the option to choose daily, weekly or monthly as shown in
Figure 4-5.
Reminders
The Reminders feature allows the user to set a reminder or notification for themselves. The user
will need to set the date, time and message. In order for the reminder feature to work the user will
need to fill their email address or their mobile number. The user will also be able view a list of the
reminders which the user has previously set. If the user has been sent a reminder, the reminder is
removed from list. The user will also be allowed to set how the message will be sent to the user
through an SMS or email. Below in Figure 4-6 is the Reminders page of the paper prototype.
Figure 4-4: Calorie Calculator Page for Paper Prototype
Figure 4-5: Record Glucose Page for Paper Prototype
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4.1.2. Evaluation and Findings
The low fidelity prototype was tested by five participants, who indicated that they willing to
participate in testing a prototype. The users were contacted and informed that they would be
compensated for their time. A set of tasks were given to the participants to give the user a sense of
what the system can do. Each of the participants did the tasks individually and after each task the
user was asked to give a comment on the design of each page. After the tasks were completed, the
participants were asked to give further comments on the system. The following tasks were given
to each user tester:
1. Enter your details in your profile.
2. Record your glucose for the day.
3. Find your past recordings.
4. View the graph.
5. Use the Calorie Calculator to check how many calories you need for the day.
6. Add calories consumed for the day.
7. Add calories you have burnt for the day. (Assuming you went to gym or just went for a
walk using a pedometer)
8. Set a reminder to go to the doctor at 14:15 on 31 August 2011.
Before testing the low fidelity prototype the users were given a brief introduction of the system.
Then the users were presented with the prototype. The outcome of the test was summarised and
analysed below.
The user testers were very interested on what the system could do. The participants were asked if
the personal details requested from the profile page were appropriate. All of the users felt the
personal details asked were satisfactory. Only one comment made on the profile page was
“Nicknames would be better to use rather than a Username”.
During tasks 2-4 participants felt recording the glucose was easy to use, quick and simple. Most
of users felt the record glucose feature could have more entries for the day especially for Type 1
diabetics, who need to check their glucose levels more than once a day. It was found by adding a
graph to view the glucose level trends; users thought it was good idea. The participants thought a
graph can be a useful tool to monitor glucose levels and should definitely be included.
The users found the calorie calculator to be easy to operate and liked the fact in choosing whether
to maintain, lose or gain weight. However, when it came to adding calories consumed the users
felt this feature should be linked with the calorie calculator and not with the home page. As the
Figure 4-6: Reminders Page for Paper Prototype
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users added the calories consumed, they liked the fact that the food was categorised in their food
groups and were able to specify the food portions. When it came to calories burned users found it
easy to use function. As the participants added the reminder it was found to be quick and easy to
use.
The participants felt the system needed a few changes and overall the system was quick and easy
to use. Users were asked if record insulin feature should be added to the system and surprisingly
the users did not want this feature as the user testers do not record their insulin intake daily.
Users were also asked whether they would use a Facebook application or a website. Most of the
users answered the Facebook application because the participants were always on Facebook.
However, participants would use the website if Facebook application did not exist. One of the
users felt the website could be better to use than Facebook application because applications can
clutter their Facebook page.
In this design iteration, a paper prototype was created and tested by users. As expected, lessons
were learned from the user evaluation. Based on the findings of the paper prototype the interface
will be refined to fix problems. The changes were made to create a prototype of high fidelity.
4.2. High Fidelity Design Iteration
Through the analysis of the low fidelity prototype improvements were made for the interface of
the website to create a high fidelity prototype. The high fidelity prototype had no functioning
back-end (server and database) and acted as a dummy website. The purpose was to give the user
an accurate sense of the system‟s interaction and get feedback of the overall design of the system.
This was also used to test the usability of the system. A total of five user testers were used, three
of the user testers were students. User testers evaluated the prototype and made note of the
problems to make further improvements for the final prototype.
4.2.1. Design
Given the results of the previous design iteration and the user testing of evaluation, a number of
changes have been made to the website interface design of the E-health diabetes self-management
system. Figure 4-7 below shows the changes made in the layout of website after low fidelity
evaluation. In analysing the user evaluation of the low fidelity prototype the following changes
were made for the high fidelity prototype.
Figure 4-7: Layout of Website (After Low Fidelity Evaluation)
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Time of day was added to the Record Glucose page.
Glucose level history was adjusted for time of day.
Add calories consumed and calories burnt buttons were moved to the calorie to allow
easier monitoring of calories, exercise and diet.
Once the changes were made to the design of the website, it was time to evaluate the high fidelity
prototype with users. The users were asked again to complete a series of tasks and give an overall
opinion of the system.
4.2.2. Evaluation and Findings
The first page the user was confronted with is shown in Figure 4-8. This is the log in page of the
E-Health Diabetes Self-management System. One of the tasks was to register as a new user on the
system. The user testers found it easy to find because the registration and log in was on the same
page. Users were asked whether they would prefer „Nickname‟ or „Username‟ and the response
was that it did not matter.
Once the users completed the task, users were brought to the profile page shown in Figure 4-9.
The users were asked again if any of the personal details were too personal and it was found to be
satisfactory.
Figure 4-8: Login Page for E-Health Website
Figure 4-9: Profile Page for Website
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Users were asked to go to the Home page shown in Figure 4-10 and to give their opinion on it. It
was found that the users liked the colours of the calories needed. One of the users suggested the
home page should have a tip on health instead of the calorie summary as the summary can be
incorporated in the Calorie Calculator.
When users used the Calorie Calculator shown in Figure 4-11, the users had a few problems with
this function. Users liked the message of how many calories are needed to maintain, lose or gain
weight. Users suggested the total amount of carbohydrates, protein and fat would help in
monitoring diet.
Figure 4-12 shows the add calories consumed and burned for the website. The users found adding
a meal to be easy but users wanted to add a new meal if the food product/s were not in the
selection boxes. As for adding calories burned most users felt it would be difficult to plug in
Calories. Users wanted a list of exercise activities and be able to add the duration of activity
instead. Most users had a common issue of the need to convert from kilojoules to Calories and
Figure 4-10: Home page for Website
Figure 4-11: Calorie Calculator page for Website
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thought it would be better to use kilojoules rather than Calories as products nutritional facts in
South Africa are measured in kilojoules.
In Figure 4-13 below shows Record Glucose and its graph pages for the website interface. Two of
the users were not satisfied with Time of Day as some diabetics record their glucose more than
four times a day and would prefer if there were about seven recordings. Most of the users were
pleased with graph as the user testers could view the current and previous day. One of the users
suggested on viewing three day history instead of two days. User testers were asked about the
weekly and monthly graphs. The user testers did not like the fact the weekly and monthly graph
would have daily or weekly glucose averages.
Taking into account all the feedback from the user evaluation. We were now ready to develop a
final prototype of the system which takes suggested improvements into consideration, but first we
had to design the back-end of the E-health system.
Figure 4-12: Add Calories Consumed and Calories Burned foor Website
Figure 4-13: Record Glucose and Graph page for Website
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4.3. Database Design
Figure 4-14 shows the design of the database. The database was used to store all user information
pertaining to the system. „PK‟ refers to the primary key of the table and „FK‟ refers to the foreign
key constraints. Foreign key constraints allows for the integrity of the system to remain intact if a
user were to be removed from the system all entries associated with the user will also be removed.
All fields in bold were required by the database and could not be NULL or left blank.
The design was centred on the „User‟ table. All user information was mapped to the „Username‟.
The „Username‟ is used to locate all the information in the database pertaining to a particular user
and serves as user ID for the user. Every feature has its own table and is linked to a user via the
„Username‟ foreign key. The „Consumes‟ and „Daily_Exercise‟ tables were used to monitor the
users‟ food consumption and daily exercise. In the high fidelity design iteration users wanted to
add a new meal which was stored in the „UserFood‟ table. „UserCalorieActivity‟ table was used to
calculate the total amount of calories consumed, calories burned, carbohydrates consumed,
proteins consumed and fats consumed for the user on a specific date. A decision was made that
users should able to give any suggestions, improvements, additions or personal requests for the
system which was stored in the „Feedback‟ table. Most of the tables were used to monitor the
activity of the users. The „Food‟ and „Exercise‟ tables were used to store the different food and
exercise that the user could use from the system. The „Food‟ table stored the name, type and the
nutritional information for a specific portion. As users wanted different exercise activities was
stored in the „Exercise‟ table and was used to store the METs values which was used to calculate
the calories burned.
Figure 4-14: Database Design
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4.4. Server Design
The server is the backbone of the system and allows different components to communicate with
each other. The following is a list of tasks the server needs to perform for the system:
Communication with database
The server needs to be able to retrieve and insert data into the database depending on the
request it receives from the different components. All components of the system will
make use of a central database to keep information viewed from the different components
consistent.
Hosting of Website
The website will be hosted on the server and needs to allow users to access the website
through the internet.
Communication between the Website Interface and database
The website needs to be able to communicate with the central database to retrieve and
insert information.
Communication between the Mobile Application and database
The server must allow the mobile application to insert entries for the users into the
database. The mobile application stores entries for the user on the phone until the user
decides to synchronise and upload entries into the database. This requires only one
connection at a time and was decided on hyper text protocol (HTTP) post request would
be suitable for the connection as it is widely used protocol to receive and send data over
the internet.
Creation of graphs and tables
Based on the glucose levels and reminders enters on the website the server should be able
to retrieve the correct values from the database and then the graph and tables should be
created from these values. The graphs and tables will be displayed depending on the
request made by the different components.
4.5. System Requirements
The final stage of the design process is to determine the hardware and software components
required for the system. Through the design a complete system we are now aware of what
resources the system requires.
4.5.1. Hardware Requirements
The website will be hosted on the server and must have a consistent connection to the internet.
The mobile application must have the ability to connect to the server. A computer with an active
and reliable connection to the internet would be sufficient.
4.5.2. Software Requirements
The use of open source software will be utilised where ever possible for the system. The
following is a list of software components needed to create a fully functioning system:
Operating System
The server needs an operating system to be a functional system and it was decided to use
the latest version of Windows to run the server
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Web server software
The server requires software which allows the system to be connected over the internet
therefore web server software was needed. Apache Tomcat web server software was
selected to run on the server. Apache Tomcat is available at tomcat.apache.org.
Database Software
MySQL is open source software that is the most widely used in the industry and there are
many resources which can help with development of the project. MySQL is available at
www.mysql.com.
Server side scripting Software
The website pages need to be dynamically created, Java Servlets was the chosen language
to produce the website pages. Java Servlets has many beneficial features for the
implementation stage which includes connecting to the database. Resources on Java
Servlets tutorials are available at Servlet-Tutorial.
4.6. Conclusion
This chapter has explained the design process necessary for the user requirements and
specifications. Now all of the hardware and software requirements are known and a completed
system can be implemented. The next chapter focuses on the implementation process.
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5. Implementation Chapter
This chapter will outline the creation of the system based on the design specification of the
previous chapter. All the necessary software was installed and configured on the server. The
software utilised were MySQL, Java Servlets and Tomcat Apache. MySQL was used to create the
database which was discussed in the design chapter shown in Figure 4-14. Md5 encryption was
used to store passwords of users. After the back-end was fully functional, the website could be
implemented. The website would consist of Java Servlet pages and was divided into different
components of the system. This section describes the features of the completed system and
emphasizes on the website changes found in the previous section.
5.1. Final Prototype Design Iteration
This iteration involves creating a fully functional system which would be evaluated by users. The
following sections describe the features of the E-health Diabetes Management System.
5.1.1. Login and User Registration
The first page the user is presented with is the login page where the user is given the option to
register as a new user or login as a registered user. In order to register the user needs fill in the
required fields. All fields are optional except username, password and gender. The server checks
the inputs when the form is submitted and gives an appropriate error message if an error was
found. The required fields marked with a „*‟ are checked first. As the user cannot see the
password entered, they are asked to enter it twice to avoid typing errors. Both passwords were
checked by the server if they do not match an appropriate error message is given. The server
requires the username to be unique and checks if username exists to give a relevant error message.
Once the requirements were met the user was inserted into the database using a SQL INSERT
command. The user is then logged into the My Profile page which is the first screen when you
register. When user logs in for the second time the user is directed to the „Home‟ page.
Figure 5-1: Login/Registration page for Final Prototype
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5.1.2. Home
The user is taken to the „Home‟ page, shown in Figure 5-3, where the user is greeted and given a
tip for the day to give the user a basic health advice for each day. The user is given a navigation
pane shown on the left of Figure 5-3 to allow user to navigate through the website. This page is
the first page the user is presented with when the user logs into website.
5.1.3. My Profile
The „My Profile‟ page, shown in Figure 5-3, is the first page the user is presented upon
registration. This page allows the user to place some of the users‟ personal information. Most of
the personal information is optional except for username, password and gender. Once the user
completes the necessary personal details the user can update the profile page or cancel. In
updating the page the user is given a notification of updated the profile page was successful.
5.1.4. Calorie Calculator
If the user chooses to utilize the „Calorie Calculator‟ page, shown in Figure 5-4, the user is given
the option to place their weight, height and goal to calculate the amount of calories needed to
achieve the goal selected. The option of selecting how active the user is; was removed due to
allowing the user to add calories burned which can determine how active the user is.. If the user
clicks calculate the user is presented with an appropriate message of the amount of kilojoules
needed to achieve their goal along with the amount of grams needed for carbohydrates, proteins
and fats which was suggested by users in the design chapter. The calories were converted to
kilojoules to give the user an easier way to input values. Below the „Calorie Calculator‟ page, the
user is given the option to add calories consumed and burned for the day. The user can view the
amount of kilojoules they consumed and burned for the day as well as resetting it to zero. If the
user wants to add calories consumed, the user is given the option to enter the amount of kilojoules
with its description and/or selecting an option in the drop down box with entering the portion size,
Figure 5-2: Home page for Final Prototype
Figure 5-3: My Profile page for Final Prototype
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displayed in Figure 5-5. This allows the user to select a meal and/or enter a new meal which was
suggested by users in the design section. If the user clicks „Add Meal‟ the kilojoules needed is
subtracted to give the user the real amount of kilojoules the user still needs for the day. In the user
evaluation of the high fidelity prototype users wanted to select an exercise activity. In order to
achieve this a consultation with an exercise expert was needed to make the system more accurate
on the amount of calories burned. Michael Lambert a professor at Sport Science Institute was
approached and asked to assist in developing a feature that can calculate the amount of calories
burned from a particular exercise. In which the professor gave calculations and resources to build
this feature. As of such if the user chooses to add calories burned, shown in Figure 5-6, the user is
given the option to select the exercise activity with the total duration of activity and to enter the
amount of kilojoules found on a pedometer. If user clicks „Submit‟ the kilojoules burned is added
to the total amount kilojoules needed to give the real amount to the user. If the user consumes to
much kilojoules, the kilojoules needed is changed from red to green which will tell the user that
the amount consumed was enough for the day.
Figure 5-4: Calorie Calculator page for Final Prototype
Figure 5-5: Calorie Consumed page for Final Prototype
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5.1.5. Record Glucose
If the user clicks „Record Glucose‟ on navigational pane, the user is taken to the Record Glucose
page, shown in Figure 5-7 to allow user to enter the glucose level, select the time of day and date
of glucose reading. Once the user clicks „Submit‟ the user is presented with an appropriate
message to notify if entry was successful. The glucose reading is also shown in the „Sugar Level
History‟ table. As shown below in Figure 5-7 the user is given the option to select 1 of 7 times of
the day which was suggested by a user in design chapter. If the user clicks „View Graph‟ the user
is presented with a bar graph with the three recent days of sugar level entries. The three days were
colour coded to the day of reading which is shown in Figure 5-8. The option of choosing weekly
and monthly was not completed due to time constraints. As it was not needed for the amount of
time the user will test the system which is discussed in the next chapter.
Figure 5-6: Calorie Burned page for Final Prototype
Figure 5-7: Record Glucose page for Final Prototype
Figure 5-8: Graph of Record Glucose for Final Prototype
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5.1.6. Reminders
As the user selects „Reminders‟ in the navigation pane, shown in Figure 5-9, the user can set the
time, date, message and how the reminder or notification will be sent to the user. The message
will only be sent if the user fills in the email or cellphone number in the user‟s profile. The user is
also given the option to remove the reminder in the list of reminders.
5.1.7. Contact Us
The user was given the option to give feedback for improvements on the system as the users will
do a pilot test the system which is described in the next section. If user decides to give feedback
the user can send a message by clicking the appropriate message.
5.2. Conclusion
All the design specifications were implemented to develop the fully functional system and it is
now essential to test the system which is the focus of the next section.
Figure 5-9: Reminders page for Final Prototype
Figure 5-10: Contact Us page for Final Prototype
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6. Testing, Evaluation and Findings
After the E-health diabetes management system was implemented and it was time to test the
system with users. A total of three users where used in the testing process as other users were
unavailable at the time. In giving the users the fully functional system for five days will give an
accurate result on the systems usage.
6.1. Pilot Test
The main aim of a pilot test is to test the functionality and to test the system in a „real world‟
environment as well as gather data upon usage. This study gives a more accurate result of the
system as the system is tested under „real world‟ conditions. The users were given the fully
functional system and a pedometer for a total of five days and then were given an evaluation form
to assess the system. None of the users were given an instruction manual to help use the system.
The next section discusses the findings of the pilot test.
6.2. Findings
After the five day pilot test users were given an evaluation form which relates to the users
experiences from utilising the system. An example of the evaluation form is given the appendix.
The following is a list of findings from the five day pilot test:
Users found recording of glucose readings were quick and efficient.
Viewing glucose level history was helpful.
Graphs were helpful.
SMS reminder was mostly used.
None of the user testers used the Email reminder option.
Reminder feature was easy to use and sent reminders at the correct time.
User testers felt calorie calculator was easy to use and helpful..
User testers felt it was helpful to monitor diet by adding calorie consumption.
Most of the users felt that the daily exercise motivated to be active.
The system assisted user testers with their management of diabetes.
The system was quick use and did not take a lot of their time.
System was user friendly as users were not confused in the usage of the system and did
not have to think on what to do.
Users felt the system gave accurate results.
Cost was not a factor in using the system.
The system was easily accessible to every user.
Users would like to continue to use the system.
o Monitored the food intake for the day.
o Managed glucose levels better.
o Encouraged to manage diabetes more carefully
o Liked the option of a website, Facebook or mobile platform.
Users did not use the pedometer as they felt that it was inaccurate.
After the initial five day pilot test the functional system was left to run and users who would like
to continue to utilise the system could do so. A Facebook support group leader was asked to look
at the Facebook application and online web interface. The Facebook support group leader then
30
posted a link on the Facebook group wall. Random users started utilising the Facebook
application and website which shows that the system has great potential to assist many users in
self management of diabetes.
6.3. Conclusion
The five day pilot test revealed that we developed a system which met the user requirements
which is easily accessible and low on cost for online participants. This system could be a
foundation of further research into diabetes self management techniques.
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7. Conclusion and Future Work
We believe the project was successful as we achieved our goals. This was confirmed by the user
feedback. All features and requirements that were outlined in the design chapter were
implemented and users were satisfied with the end result. The five day pilot test proved to be a
helpful process as it gave a sense of „real world‟ interaction with the system which in turn gives
an accurate result. The users found the system to be low in cost and the easily accessible. The
system was found to be a useful tool in the management of diabetes. However, as technology
evolves so will the user requirements and expectations. Further testing and implementation will
keep evolving the system to remain a powerful tool in self-management of diabetes.
7.1. Future Work
The following is a list of future work derived from the overall project:
Involve Diabetes South Africa Support Groups
Throughout the development of the system the support groups from DSA were excluded
as they did not have the technology for us to develop a system for them. In providing the
technology for the support groups, they too can be involved in developing a system and
the result can be an asset to the research.
Leave the system running online
As noted towards the end of the project the system was utilised by random users accessed
Facebook application and website which shows that the system has great potential. The
outcome of this can end in an interesting result.
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8. References
1. A.D.A.M., 2011. Diabetes – PubMed Health
http://www.ncbi.nlm.nih.gov/pubmedhealth/PMH0002194/
2. A.D.A.M., 2011. Type 1 diabetes - PubMed Health.
http://www.ncbi.nlm.nih.gov/pubmedhealth/PMH0001350/
3. A.D.A.M., 2011. Type 2 diabetes - PubMed Health.
http://www.ncbi.nlm.nih.gov/pubmedhealth/PMH0001356/
4. BROWNSTEIN, C., BROWNSTEIN, J.S., WILLIAMS, D.S., WICKS, P., AND
HEYWOOD, J. The power of social networking in medicine. Nature biotechnology 27, 10
(2009), 888-90.
5. CARTER E.L., NUNLEE-BLAND G., CALLENDER C., 2011. A Patient-Centric, Provider-
Assisted Diabetes Telehealth Self-management Intervention for Urban Minorities. Available
from http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3035826/ (2011); accessed 2 October
2011.
6. CLARK M., HAMPSON S.E., AVERY L., SIMPSON R., 2010. Effects of a tailored lifestyle
self-management intervention in patients with type 2 diabetes. British Journal of Health
Psychology, 9, 3, 365-379.
7. DEMAND MEDIA, 2011. Diabetes Effects on Society | eHow.com.
http://www.ehow.com/facts_5513758_diabetes-effects-society.html
8. DHILLION, J.S., LUTTEROTH, C, WÜNSCHE, B.C., 2011. Leveraging Web 2.0 and
Consumer Devices for Improving Elderlies‟ Health. Knowledge Management 120.
9. DIGITAL ALTITUDES, 2010. Diabetes Software and iPhone Diabetes App for Mac, iPhone,
Windows, Palm and PC : Diabetes Pilot. http://www.diabetespilot.com/
10. DIABETIC LIVE, 2011. Popular Social Networking Websites And Diabetes | diabetes.
http://www.diabeticlive.com/diabetes-101/diabetes-news/popular-social-networking-
websites-and-diabetes/
11. FROST, J. AND MASSAGLI, M., 2009. PatientsLikeMe the case for a data-centered patient
community and how ALS patients use the community to inform treatment decisions and
manage pulmonary health. Chronic respiratory disease 6, 4, 225-9.
12. GREENE, J., CHOUDHRY, N.K., KILABUK, E., AND SHRANK, W.H., 2010. Online
Social Networking by Patients with Diabetes: A Qualitative Evaluation of Communication
with Facebook. Journal of general internal medicine, 287-292.
13. HAWN, C., 2009. Take two aspirin and tweet me in the morning: how Twitter, Facebook, and
other social media are reshaping health care. Health affairs (Project Hope) 28, 2, 361-8.
33
14. HEINRICH, E. DE NOOIJER, J. SCHAPER, N.C. , SCHOONUS-SPIT, M.H.G.,
JANSSEN, M.A.J., DE VRIES,N.K., 2011. Evaluation of the web-based Diabetes Interactive
Education Programme (DIEP) for patients with type 2 diabetes. Patient Education and
Counselling.
15. HEISLER M., BOUKNIGHT R.R., HAYWARD R.A., SMITH D.M., KERR E.A., 2002. The
relative importance of physician communication, participatory decision making, and patient
understanding in diabetes self-management. Journal of General Internal Medicine, 17, 4,
243-252.
16. HELLER, A. AND FELDMAN, B., 2010 Electrochemistry in diabetes management.
Accounts of chemical research 43, 7, 963-73.
17. MEDILEXICON INTERNATIONAL LTD, 2011. What is Diabetes? What Causes Diabetes?
http://www.medicalnewstoday.com/info/diabetes/
18. NEAL, D.M., 2010. The conundrum of providing authoritative online consumer health
information: Current research and implications for information professionals. Bulletin of the
American Society for Information Science and Technology 36, 4, 33-37.
19. PEARSON, J.F., BROWNSTEIN, C., AND BROWNSTEIN, J.S., 2010. Potential for
Electronic Health Records and Online Social Networking to Redefine Medical Research.
Clinical chemistry 204.
20. SHACHAK, A., 2011. Electronic Health Records in the Age of Social Networks. 303, 5.
21. SWAN, M., 2009. Emerging patient-driven health care models: an examination of health
social networks, consumer personalized medicine and quantified self-tracking. International
journal of environmental research and public health 6, 2, 492-525.
22. WILLIAMS G.C., MCGREGOR H.A., ZELDMAN A., FREEDMAN Z.R., DECI E.L.,2004.
Testing a Self-Determination Theory Process Model for Promoting Glycemic Control
Through Diabetes Self-Management. Health Psychology, 23, 58-66.
23. WILLIAMS G.C., MCGREGOR H.A., ZELDMAN A., FREEDMAN Z.R., DECI E.L.,2005.
Promoting glycemic control through diabetes self-management: evaluating a patient
activation intervention. Patient Education and Counselling, 56, 1, 28-34.
24. YANG, C.C., 2010. Identifying influential users in an online healthcare social network. 2010
IEEE International Conference on Intelligence and Security Informatics, 43-48.
25. ZYWICA, J. AND DANOWSKI, J., 2008. The Faces of Facebookers: Investigating Social
Enhancement and Social Compensation Hypotheses; Predicting Facebook™ and Offline
Popularity from Sociability and Self-Esteem, and Mapping the Meanings of Popularity with
Semantic Networks. Journal of Computer-Mediated Communication 14, 1, 1-34.
34
9. Appendices
9.1. Appendix A: Questionnaire
CSC4000W E-Health Project
DIABETES RESEARCH QUESTIONNAIRE
Thank you for participating in this research. This questionnaire forms part of the investigation into
the development of low cost and easily accessible Diabetes Management Software with Social
Networking Support. Your answers will be regarded as strictly confidential and you do not need to
fill out any personal information.
You do not need to answer any questions that you would prefer to leave unanswered, but a
better/more meaningful result will be obtained if you attempt to answer all questions. Please mark the
box that contains the most appropriate response with an X. The questionnaire should take around 15
minutes to complete.
Basic Information
1. Please Mark the age group that you belong to
0-20 Years 21-30 Years 31-40 Years 41-50 Years 51-60 Years Over 60 Years
2. What type of Diabetes do you have?
Type 1 Type 2 I don‟t know
Questions on Diabetes Management
3. How often do you consult the doctor?
More than Once a
Month
Once a Month Less than Once a Month
35
4. a) Do you own or use a blood glucose meter at home?
b) How often do you perform the following tasks? (Please Mark the most appropriate box with an
X in each row)
Tasks Daily Weekly Monthly Less than Once
a Month
Never
Measure Blood Glucose
levels
Monitor Diet
Monitor Insulin
Monitor Physical Exercise
Monitor Medication
Monitor Weight
Others:
(Please Specify below)
5. With whom do you discuss the state of your diabetes for the following tasks?
(You can select more than one box in each row or you can also leave the row blank)
Tasks Doctor Family Friends Other
Diabetics
Acquaintances Strangers
Blood Glucose
levels
Diet
Insulin
Physical Exercise
Medication
Weight
Others:
(Please Specify
below)
6. Do you belong to a Diabetes support group?
If YES, how did you become aware of them?
_____________________________________________________________
If possible, please state the name of the support group
______________________________________________________________
YES NO
YES NO
36
7. If you had the opportunity, what information would you like to view about other diabetics and
would you want share information on your diabetes condition?
Please fill in the table below with an X on what is applicable to you.
Factors
View Information from other
diabetics
Share your information
Yes Neutral No Yes Neutral No
Sugar Levels
(viewing glucose levels)
Physical Exercise
(viewing exercise plan)
Mood
(viewing mood changes)
Medication
(viewing medication taken)
Other Remedies
Blood pressure
(viewing blood pressure
measurements)
Diet
Any Other factors
(Please Specify Below)
37
8. Which of the following tasks are important for you in managing your diabetes?
Daily Weekly Monthly Less than Once a
Month
Never
Viewing Blood pressure
history
Viewing past cholesterol
levels
Viewing trends in glucose
levels
Viewing your diet plan
history
Viewing your exercise
plan history
Viewing medication
intake history
Viewing weight history
Viewing past sleep
patterns
Seeking advice online
Notification service on
when to take insulin,
tablets etc.
Viewing past insulin
intake
9. From where do you have access to the Internet?
(You can select more than one answer)
PC/Laptop Cell Phone Library NO INTERNET ACCESS
Internet Cafe School University
Other Option(s) (Please Specify):
_____________________________________________________________
10. If you had a website that you could access in order to assist in managing your diabetes, how
would you want to view the online information? (You can select more than one answer)
Using a
PC/Laptop
Using a
Cellphone
NEITHER
38
Questions on Cellphone Use
11. Do you have a cellphone for personal use?
YES NO
If NO, please skip to Question 20.
12. What type of phone do you use?
Brand
Apple Blackberry HTC LG
Motorola Nokia Samsung Sony Ericsson
Other (Please Specify)
Model (Please Specify: e.g. E250; Desire; iPhone; etc.)
__________________________________________________
13. How often do you use your cellphone for performing the following tasks? Please mark the box
with the most approximate answer in each row.
Hint: Often = More than once every 2 days
Less often = At least once every 2 weeks
Rarely = Less than once every 2 weeks
Task Result
Often Less Often Rarely Never
Sending SMS
Surfing the Internet
Playing Games
Often Less Often Rarely Never
Listening to Music
Taking Pictures
Sending Emails
Using Social Networking Apps
e.g. Facebook, Twitter, BBM Chat etc
Using GPS e.g. for Navigation
14. How much money do you spend on cellphone expenses each?
Less than R50 R50 – R100 R100-R200 R200-R400 More than R400
15. How much extra would you be willing to spend on cellphone expenses each month to manage
your diabetes?
Less than R50 R50 – R100 R100-R200 More than R200
39
16. How do you regard the internet connectivity on your cellphone?
Slow and difficult to
connect
Slow but usable Sometimes slow,
sometimes fast
Fast
Other (Please Specify) _________________________________________________
17. Would you prefer to send and receive updates if you installed and used software on your
cellphone by going to a specific location where you can connect to the database directly? This
option would reduce or eliminate the cost that would have been incurred by using the
cellphone‟s internet connection.
YES NO
18. If you selected YES above, please select or state which locations that you would prefer to go to in
order to send and receive updates?
Hint: Often = At least once every 3 days
Less often = At least once every week
Rarely = Less than once every week
Location No of Times Visited
Often Less Often Rarely
Shopping Mall
School
Community Centre
Other: Please Specify Below
19. Would you be interested in receiving locations of stores that have specials on necessities based on
your cellphone GPS location in a shopping mall?
YES NO
If YES, please briefly state why you would be interested.
______________________________________________________________
40
Questions on Social Networks and Social Support
20. Are you engaged in at least one of the following online social networks?
YES NO
If YES, please complete the table below
Social Network Login Frequency
Daily Weekly Monthly Less than
Monthly
Not a
member
MySpace
Friendster
Bebo
Orkut
Other: (Please Specify Below)
If No, please skip to Question 27
21. On average how much time do you spend on the most preferred social network per week?
Less than an Hour 1-2 Hours 3-4 Hours 4-6 Hours More than 6 Hours
22. What do you use the social network for? Please mark the box with the most approximate answer
in each row.
Task Frequency
Yes very
often
Yes but
rarely
No
Find New Friends
Play Interactive Games
Chat & Comment
Check Out Your Friends
Update Your Profile
Pass Time
Spread Awareness About
Health
Seek Healthcare
Information
41
23. Would you prefer social networks to educate you and other diabetics more about diabetes?
YES NO
24. Would you prefer to use social networks to receive notifications relating to your medications and
appointments?
YES NO
25. Would you like to engage with other diabetics and share experiences related to diabetes? Please
give a reason for yes or no.
YES NO
Reason________________________________________________________
______________________________________________________________
26. If you could, would you use your social network(s) to manage diabetes?
YES NO
If No, please give a reason below:
Reason________________________________________________________
______________________________________________________________
42
Research Study
27. Would you be interested in testing a prototype system that we will be developing in the next 5
months?
The testing will range from either a few minutes of your time or an evaluation that will involve
using the final system for a few days or a few weeks. We would contact you at a later stage and
ask you if you are available. We promise to ensure that all information that you share with us is
kept confidential.
YES NO
If YES, please fill out the following details below so that we can contact you at a later stage
of the project.
Name ___________________________________________
Telephone________________________________________
Cellphone_________________________________________
Email Address_____________________________________
Which shopping centre or shopping mall do you mainly go to? (e.g. for going to the gym
and/or shopping and/or socializing/recreation, etc). This will help us to select which
locations to collect data on specials, store discounts etc.
____________________________________________________________
Thank you for your time!
43
9.2. Appendix B: Evaluation Form for Final E-Health Prototype
E-HEALTH Evaluation of the final E-Health 5-day prototype pilot testing
Please answer the following questions in relation to your experience in the event or activity you have
just completed. These questions relate to the thoughts and feelings you may have experienced while
taking part. There are no right or wrong answers. Think about how you felt during the event/activity,
and then answer the questions using the rating scale below. For each question circle the number that
best matches your experience.
During the: ____________________ (website / cell / facebook E-Health)
Strongly
Disagree
Disagree Neither
Agree
nor
Disagree
Agree Strongly
Agree
Not
Applicable
1 I felt my details stored on the
system were not too personal
1 2 3 4 5 6
2 I felt that recording my glucose
readings were quick and
efficient
1 2 3 4 5 6
3 I felt that recording my insulin
readings were quick and
efficient
1 2 3 4 5 6
4 I felt that the display of my
glucose history was very helpful
1 2 3 4 5 6
5 I felt that the graphs showing
my past glucose levels were
helpful
1 2 3 4 5 6
6 I mostly used the SMS reminder
feature
1 2 3 4 5 6
7 I mostly used the Email
reminder feature
1 2 3 4 5 6
8 I felt that the reminder feature
was easy to use
1 2 3 4 5 6
9 I felt that the reminder feature
sent all reminders to me at the
correct time
1 2 3 4 5 6
10 I felt that the calorie calculator
was easy to use
1 2 3 4 5 6
11 Entering food consumptions
allowed me to monitor my diet
1 2 3 4 5 6
12 Entering my daily exercises
encouraged me to be more
active
1 2 3 4 5 6
13 I found the results of the calorie
calculator very helpful
1 2 3 4 5 6
14 I was able to easily contact the
E-Health team for any queries or
suggestions
1 2 3 4 5 6
15 I felt that the system assisted me
with the management of
diabetes
1 2 3 4 5 6
16 I felt that using the system was
quick and it did not take a lot of
my time
1 2 3 4 5 6
44
Continued… Strongly
Disagree
Disagree Neither
Agree
nor
Disagree
Agree Strongly
Agree
Not
Applicable
17 I did not have to think of what to
do when using the system
1 2 3 4 5 6
18 I was not confused when using
the system
1 2 3 4 5 6
19 I felt that the system gave
accurate results
1 2 3 4 5 6
20 I felt that the extra cost incurred
in using the system was
insignificant
1 2 3 4 5 6
21 I felt that I could easily access
the system
1 2 3 4 5 6
22 I would want to continue to use
the system to manage diabetes
and reason
1 2 3 4 5 6
