Sugar Ka Saathi – A Case Study Designing Digital Self-management Tools for People Living with Diabetes in Pakistan

Abstract

This paper presents the results of an iterative participatory process to design a smart self-management tool for less-literate people living with diabetes in Pakistan. Initially, interviews and focus groups with sixty-nine people living with diabetes identified issues that they face when self-managing including uncontrollable factors, lack of diabetes awareness, low-tech mobile phones, and poor internet availability. We developed personas grounded in the scoping results and adjusted our PD approach to focus on more tangible design artefacts before running narrative scoping PD sessions. Working from older, illiterate persona, we designed a phone-line delivered Interactive Voice Response (IVR) system. We developed a functional IVR Prototype "Sugar ka Saathi" (Diabetes Companion) with input from a group of 4 Pakistan-based healthcare professionals, to act as a design probe in the PD process. We tested the IVR probe with fifty-seven of the original scoping participants which validated the knowledge transferred by the IVR and its acceptability. Invisible design videos were shown to elaborate the IVR and community concept to thirteen participants through two filmed videos using our existing persona characters from the scoping studies, these videos helped to engage older people with diabetes in PD sessions.

Codesign in resource-limited societies: theoretical perspectives, inputs, outputs and influencing factors

“…Involvement of resource-constrained people in design and development of solutions has been defined or described in many ways and terms, offering various perspectives on the integration of knowledge and capabilities of relevant partners (Rosca and Bendul 2016). For example, whilst some studies use the term co-creation (Hernandez-Cazares et al 2019;Dalvit et al 2013;Funamizu 2017;Galafassi et al 2018), others employ terms such as codesign or participatory design (Zeb et al 2019;Nthane et al 2020;Mwanzia and Misati 2013), emphasising involvement of resourceconstrained people or a broad range of partners for sharing information or for offering suggestions in the design and development process to realise value for the involved stakeholders, including resource-constrained people (Bharti 2014, Rosca andBendul 2016;Jagtap and Larsson 2019). Nahi (2016), for instance, defines cocreation in the context of resource-constrained communities in developing countries as "iterative interaction that empowers resourceconstrained communities and integrates their knowledge and capabilities with those of a company and other actors" throughout the process of designing solutions.…”

Designing Technology for less literate people with diabetes in Punjab, Pakistan

“…This testing was followed by presenting invisible design videos to thirteen people with diabetes (a subset of the 57 people involved in IVR Prototype One testing.) [270].…”

“…for example, older people with diabetes from China are more likely to take care of themselves [271]. Pakistan has mixed behaviour towards diabetes management depending on personal motivation, behaviour, and resources [270]. Education at higher levels influences diabetes management positively [191], but the role of gender in diabetes management remains unclear.…”