Identifying and Planning for Individualized Change

Abstract

Identifying and planning strategies that support a healthy lifestyle or manage a chronic disease often require patient-provider collaboration. For example, people with healthy eating goals often share everyday food, exercise, or sleep data with health coaches or nutritionists to find opportunities for change, and patients with irritable bowel syndrome (IBS) often gather food and symptom data as part of working with providers to diagnose and manage symptoms. However, a lack of effective support often prevents health experts from reviewing large amounts of data in time-constrained visits, prevents focusing on individual goals, and prevents generating correct, individualized, and actionable recommendations. To examine how to design photo-based diaries to help people and health experts exchange knowledge and focus on collaboration goals when reviewing the data together, we designed and developed Foodprint, a photo-based food diary. Foodprint includes three components: (1) A mobile app supporting lightweight data collection, (2) a web app with photo-based visualization and quantitative visualizations supporting collaborative reflection, and (3) a pre-visit note communicating an individual’s expectations and questions to experts. We deployed Foodprint in two studies: (1) with 17 people with healthy eating goals and 7 health experts, and (2) with 16 IBS patients and 8 health experts. Building upon the lens of boundary negotiating artifacts and findings from two field studies, our research contributes design principles to (1) prepare individuals to collect data relevant to their health goals and for collaboration, (2) help health experts focus on an individual’s eating context, experiences, and goals in collaborative review, and (3) support individuals and experts to develop individualized, actionable plans and strategies.

The Importance of Starting With Goals in N-of-1 Studies

“…Across this research, we have surveyed 1,396 people with chronic conditions, and conducted interviews, participatory design sessions, or focus groups with 108 people with chronic conditions and 32 health providers (9,(15)(16)(17)(18)(19)(20)(21). We also draw on three field deployments of novel prototype systems with 48 people (22,23). Although most these studies were grounded in specific conditions (irritable bowel syndrome, migraine, juvenile idiopathic arthritis) or health behaviors (sleep, healthy eating), we anticipate the implications of this research apply broadly to n-of-1 studies.…”

“…We then examined how interactive, exploratory visualizations can help people and their health providers better interpret their data and collaborate with each other ( 17 ). We further developed Foodprint, a photo-based food journaling system that reduces burden and explicitly elicits the patient’s goals to better support personalized, actionable, collaborative review ( 23 ). Finally, we examined how self-experimentation could help people determine causality between a symptom and trigger ( 22 ).…”

“…Designs can also support communication about goals between patients and providers. In our food tracking research, we designed a pre-visit note to support explicit patient-provider communication about goals ( 23 ). The note elicited patient goals for the visit, their own summary of their data, and their questions for health providers.…”

“…To support healthy eating and IBS management, Foodprint supported configurations specific to different goals ( 23 ) ( Figure 2 , left). For example, when individuals expressed a healthy eating goal of “eating more balanced meals,” we configured their app to support annotating food groups (fruits, vegetables, grains, protein, dairy, oils).…”

“…Each n-of-1 design has a range of possible analysis approaches. In our correlational analysis of food photos, we explored both visual analysis of photos grouped by symptom severity and quantitative analysis graphing correlations between nutrients and symptoms ( 17 , 23 ). Both approaches had advantages.…”