SAT116 Utilizing User-centered Design And Usability And Skills Testing For Remote Diabetes Survival Skills Training
Authors: Freeman Stephen J , Radonski Brandon , Lecka Liam , Davis Ka'Derricka , Prince Grace , Carthy Kevin , Seley Jane J , Song Jing , Lee Jungwha , Bailey Stacy C , Khorzad Rebeca , Gatchell David , Ankenman Bruce , Lewis Daniel R , Holl Jane , Wallia Amisha 
Published: October 2023

Abstract
Disclosure: S.J. Freeman: None. B. Radonski: None. L. Lecka: Employee; Self; Doximity. Stock Owner; Self; Doximity. K. Davis: None. G. Prince: None. K. Carthy: None. J.J. Seley: Speaker; Self; Lifescan Diabetes Institute. J. Song: None. J. Lee: None. S.C. Bailey: Consulting Fee; Self; Merck, Lundbeck, Sanofi-Aventis, Pfizer, Inc., Luto, University of Westminster, Gilead. Grant Recipient; Self; Merck, Eli Lilly & Company, Pfizer, Inc., Lundbeck, Gordon and Betty Moore Foundation, National Institutes of Health, Gilead. R. Khorzad: None. D. Gatchell: None. B. Ankenman: None. D.R. Lewis: Grant Recipient; Self; Pfizer, Inc., Spencer Foundation, National Institutes of Health. J. Holl: None. A. Wallia: Consulting Fee; Self; Eli Lilly & Company. Grant Recipient; Self; Novo Nordisk. Research Investigator; Self; UnitedHealth Group, Eli Lilly & Company.
Patient-centered approaches for teaching diabetes mellitus (DM) survival skills are essential. Furthermore, in the peri-COVID era, interventions also need to be amenable to remote care delivery. User-Centered design (UCD) including usability testing is a key strategy to optimize adoption and engagement of interventions. We developed a Diabetes Survival Skills Toolkit (website, paper guide, and a physical Kit with simulation supplies) using UCD (&gt; 50 sessions), followed by administration of system usability surveys (SUS) (scored as unacceptable, acceptable, or excellent) and, in a subset, additional skills testing. Skills testing included simulated blood glucose checks and insulin administration, conducted by 2 trained observers. Forty-three participants with no prior history of DM were recruited between 01/2021-07/2022 to independently learn survival skills using different Toolkit components [website only (N=11), Kit + paper guide (N=28), and Kit + website (N=4)]. Purposive sampling for age and highest education level resulted in 33% being ≥ 65 years and 35% having &lt; 4-year degree. Overall, SUS scores were deemed excellent (N=15/43 [35%]) or acceptable (N=20/43 [47%]). Unacceptable scores were noted in 8/43 (19%) [4 website only (all &gt; 4-year degree) and 4 Kit + paper guide (3 of 4 &gt; 65 years, all &lt; 4-year degree)]. Use of the website alone resulted in a higher rate of unacceptable SUS scores (37%) compared to use of the Kit with either the paper guide or website (13%). SUS-score category was not associated with age (82% acceptable/excellent among &lt;45 years, 86% among 45-64 years, and 79% among &gt;=65 years; Fishers’ p=1.00) nor highest education level (80% acceptable/excellent among &lt;4-year degree and 82% among &gt;=4-year degree; Fisher’s p=0.69). Participants who completed skills testing (N= 28 Kit + paper guide, 4 Kit + website), regardless of their SUS score, all correctly demonstrated the ability to inject insulin with simulation supplies. However, 4/32 (13%) (all SUS scores acceptable/excellent) were unable to navigate all steps independently and 9/32 (28%) (2 SUS unacceptable) did not use the recommended instructional pathway. All 4 participants (3 with &gt; age 65 and &lt; 4-year degree) who completed skills testing but had unacceptable SUS scores still correctly demonstrated the ability to measure blood glucose and inject insulin. In conclusion, a Survival Skills Toolkit, resulted in excellent rates of successful survival skills performance when tested with laypersons of diverse ages and education levels. Subjective usability (SUS scores) did differ among users of different Toolkit components; however, they did not align with actual skill performance. Design preferences and usability tests as well as subsequent skills testing are critical to optimally design tools for diabetes survival skills training.
Presentation: Saturday, June 17, 2023