Abstract: A Qualitative Study Examining Children’s Everyday Health Management Using Health Technologies

◆ Ji Youn Shin, Michigan State University
◆ Bree E. Holtz, Michigan State University

Type 1 diabetes (T1D) is one of the most common chronic diseases for children in the United States. Once diagnosed, the family must manage the disease. This complex management routine includes multiple daily blood glucose monitoring, administering insulin, calculating carbs consumed, and tracking physical activity. Recent health technologies, like mobile phone health applications (mHealth apps), have become useful tools to support this health monitoring, particularly for children. However, previous studies have demonstrated significant barriers in monitoring health information, particularly when children are at school. This is due to the school phone policies and activities that happen outside of their routine. Therefore, it is necessary to understand the children’s attitudes, behaviors, and opinions towards using mHealth interventions in their daily life and incorporating those findings into future design features.

To do this, we conducted semi-structured video interviews with children with T1D. We provided (via their parents’ email) the children with a narrative about a child managing T1D at school and several drawing forms to have them draw perceived barriers and opportunities. We also asked them to draw an mHealth intervention that would help them manage their T1D. Data collection took place between September and October 2019. The interviews were conducted with children aged 10–15 years (n=10) with T1D. Although our primary focus was to understand children’s perspectives, parents were able to participate in the conversation, if they wanted. Each interview lasted approximately 45 minutes. All interviews were audio-recorded and professionally transcribed verbatim. Overarching themes were identified through open coding and affinity diagraming, and were regularly discussed in group meetings.

Our results demonstrate the children believe that there are benefits and challenges of using monitoring technologies and mHealth apps that automatically track blood glucose values and can share information with their parents. We identified four overarching themes, including: (1) children as an active participant of diabetes management with technologies. This theme shows that the children feel ownership over the management routine of their disease. (2) Children develop their own interpersonal communication strategies as they go through the illness journey. For instance, they communicate through a heavy use of emojis. (3) Children are fast learners of new technologies. They actively seek out peripheral devices to communicate with their parents about their diabetes including conversational agents, like Alexa and Siri. (4) They have emerging fears of security and privacy issues of using technology. For example, one participant was worried about health information being “out there” if they lost their phone.

While technology is not a panacea for T1D management, we can develop better technologies through using this type of human centered design. By capturing the emerging themes in monitoring health data with technologies from the children’s perspective, we will discuss design implications to develop supporting interventions for children with T1D. Further, we will also review the benefits of using a narrative-based approach with this population and in other health contexts.