Using Human-Centered Design and Development to Create a Digital Sick Day Medication Guidance Application for People...

Diabetes, cardiovascular disease, and chronic kidney disease are associated with high morbidity and costs of care. Medications can reduce long-term complications but may contribute to complications such as hypoglycemia and acute kidney injury during acute illnesses. Sick day medication guidance (SDMG) could help prevent these adverse events, but evidence for effective strategies to deliver this guidance is lacking.

We iteratively designed and developed a digital prototype user interface (UI) to deliver SDMG for patient self-management. The application, called "Preventing medication complications during AcUte illness through Symptom Evaluation and sick day guidance" (PAUSE), delivers personalized knowledge and self-management guidance directly to patients to enhance medication self-management during acute illness, with the goal of reducing preventable emergency visits and hospitalizations and improving patient outcomes during acute illness.

Using a human-centered design (HCD) approach, we conducted iterative heuristic evaluation and usability testing paired with prototype revisions. Heuristic evaluation involved our team members evaluating the prototype's UI against established criteria. We also conducted formative usability testing with 6 patients (including a patient-caregiver dyad) to provide subjective lived experience perspectives. We analyzed data deductively and pragmatically to rapidly inform subsequent iterations.

We identified 21 and 44 design issues through heuristics evaluation and usability testing, respectively. The development team iteratively revised the PAUSE UI prototype between evaluations, with the final design providing key user flows and integrated supports and reminders for acting on severe acute illness situations that recommend pausing certain medications.

Using an iterative HCD approach, we designed and developed a digital health application to deliver SDMG for patient self-management. We addressed feasible technical and workflow barriers using iterative heuristic evaluations and usability testing resulting in a refined SDMG self-management prototype app for patients taking medications commonly used to treat diabetes, cardiovascular disease, and chronic kidney disease. Further research is needed to test the effectiveness of the current PAUSE app in helping people with these chronic conditions self-manage their medications during acute illness and evaluate the feasibility of integrating the app into community-based chronic disease care.