|Term||Source of Definition||Definition|
|User Experience||ISO 9241-210 |
|Usability||ISO 9241-11 ||“…the extent to which a user can use a product to achieve specific goals with effectiveness, efficiency and satisfaction.…|
|Human Factors (Ergonomics)||ANSI/AAMI HE75 2009 ||“…the application of knowledge about human capabilities (physical, sensory, emotional, and intellectual) and limitations to the design and development of tools, devices, systems, environments, and organizations”|
|System/Device/Service||User Experience (UX): What is the overall impression and response?||Usability: How easy is it to use?||Human Factors: How does it look, feel, sound?|
|Water Faucet||Positive||User is able to turn on the tap and control temperature, on-time and power without hesitation and without instruction||Finish on the taps affords comfortable and effective grip; no great force or awkward physical movement is required to operate the tap|
|Negative||Unintuitive controls; no means to effectively control power and on-time; no natural mapping of functions||Sharp edges on taps, slippery surface; user must exert unnecessary force to activate controls|
|Car Rental Website||Positive||User can freely navigate menus and can navigate intuitively to where they want to go, errors are limited and are easily reversed||Buttons, links and lists are clearly visible, font size is easy to read, colour scheme is agreeable, excessive clicking is minimalised|
|Negative||Options are not clearly presented; users have to randomly explore to find correct paths. User has to depend on search bar/help menu||Font is difficult to read, colour schemes make it difficult to process information, users need many clicks to complete tasks|
|Blood Pressure Measurement Device||Positive||User can put on device easily and quickly initialise measurement through button press or switch; intuitive feedback from display||Font on screen is easy to read; screen brightness is adequate; button requires little force to operate; alarms or beeps are clearly audible and adjustable;|
|Negative||Device is not easy to put on; Measurement sequence does not initialise easily or quickly; readings takes too long to show on screen; no audio/tactile feedback||Buttons and strappings are cumbersome and uncomfortable, alarms beeps are too faint or too loud, screen text is difficult to read;|
1.1. Human Centred Design: An Umbrella Term
- Understand and specify the context of use
- Specify the user requirements
- Produce design solutions
1.2. The Importance of HCD in Healthcare
1.3. Connected Health
2. Connected Health Devices for the Older Adult
Common Personal Connected Health Devices
|Connected Health Devices||Functional Analysis||Device Controls||Device Output Elements|
|Blood Pressure Monitor||User must sit still in an upright position and place the cuff on the bare skin ensuring that the arm is in such a position that the cuff height is level with the heart. User reaches and presses the start button on the unit when complete readings will then appear on screen. The displayed value is read, interpreted, and acted upon.||Buttons, arm/wrist cuff||Screen symbols and alpha/numerical characters, audible tone indicators, light indicators|
|Glucose Metre/Lancet||Device is powered on via main button. The lancing device is cocked and the depth set. The head of the device is pressed against the skin and a button is pressed which fires the lancet. Blood sample is placed on a test strip and inserted in the device. Blood glucose level in the sample is measured and value is displayed on screen, audio feature also reads out measurements. The displayed value is read, interpreted, and acted upon.||Buttons, insertion of plastic strip, depth gauge on lancet||Audio tones and verbal feedback, alpha numeric screen characters|
|Blood Oxygen Monitoring||Power on the device is typically initiated by simply placing device over the finger tip. Once aligned reading will commence and take a matter of seconds. The fingernail must be right under the LED lights and the finger must be kept still during the measurement. Readings will be displayed on screen. The displayed value is read, interpreted, and acted upon.||Button for power, Finger input||LED light, small screen with alpha numeric characters|
|Pedometer||Device is initiated using main power button. Variables such as the weight and stride length of the user must be inputted. The device is placed in a pocket, a closely held bag or attached to the belt. Readings are displayed on screen. Audio feedback can also indicate when certain milestones have been reached. The displayed values are read, interpreted, and acted upon. Most devices can store a number of days of measurements and are USB enabled to upload data to a computer.||Buttons for input settings and power||Screen, beeps, small screen with alpha numeric characters, screen symbols, some models with verbal feedback|
|Spirometer||Unit is powered on via power button and users input their anthropometric details. User can carry device around like a pedometer To enter spirometry mode the user simply clips on the mouthpiece and selects the required spirometery test from the user menu. User breathes into the mouthpiece as per the instructions on the display. Test results are displayed on screen. The displayed values are read, interpreted, and acted upon. User can save the reading on the device under their name or upload it to a computer for further software manipulation via USB or Bluetooth.||Breathing input mouthpiece, buttons, Spirodoc is touchscreen||Screen display, graphical readings, alpha numeric characters, audible tones to signify breathing test sequences|
|Weighing Scales||The device pairs up automatically with any available Bluetooth device. To initiate the reading the user has only to step onto the scales. The scale calibrates and produces a reading within 3 s and automatically sends the reading to a nearby device via Bluetooth. The displayed values are read, interpreted, and acted upon.||Stand on scales, calibration/mode change possibly required with buttons||Reading appears on screen numeric display, voice feedback|
|Thermometer||Device initiated by pressing the On Measure button. Place probe under tongue or in arm pit. When the reading is ready, the device will emit a tone to indicate reading complete, the displayed values are read, interpreted, and acted upon.||Buttons, placement of metallic strip at indicated site||Tones to signify reading, numerical output on screen|
|ECG Scanner||Powered on by pressing power button on the front of the device. User presses their index finger on the metallic electrodes on one end of the device and then presses the other end of the device against their chest. User presses the start button and must hold position for 30 seconds for the measurement to complete. Readings are displayed on screen. The user is asked whether they want to store the data. The display will show the ECG waveform, the heart rate and a letter from a-m corresponding to what the waveform reading entails about the condition of the heart. The displayed values are read, interpreted, and acted upon.||Power and settings button, placement of finger on metallic strip||Tones to signify reading, alpha numerical characters on display|
3. The Older Adult User
3.1. Perceptual Changes with Ageing
|Low Contrast Acuity (LCA)||The clarity of vision when viewing low contrast surfaces, for example grey scale images are considered low contrast.||20/27||1.1||1.2||1.5||1.8||2||3||4|
|High Contrast Acuity (HCA)||The standard measure of visual performance is taken by measuring high contrast acuity.||20/20||1||1||1.1||1.2||1.3||1.5||2|
|Low Contrast Acuity in Low Luminance (LCALL)||Similar to LCA except in poorly lit environment. Home lighting can be as much as 4 times dimmer than a work or office environment.||20/40||1.5||1.7||2||2.5||3||4||6|
|Acuity in Glare (AG)||The ability to focus vision when competing light sources are present in the environment, this is sometimes referred to as disability glare.||20/40||1.9||2||2.5||3||3.5||6||18|
|Colour Discrimination (CD)||A person’s ability to distinguish between objects or lights having different colours.||10 (D-15 Score)||1||1||1||1||1||2.5||5|
|Contrast Sensitivity (CS)||A person’s ability to visually distinguish an object that is poorly contrasted with its visual surroundings.||1.85||1.1||1.2||1.3||1.5||3||3.5||6|
- Discriminating colours and contrast on a screen, particularly in low luminance settings.
- Reading small, decorative or poorly weighted fonts.
- Distinguishing between similarly shaped software icons on screens or icons on labels.
- Coping with glare on a screen or maintaining concentration when glare from external sources are present in the environment.
- Reading scrolling text.
- Taking in information from a large field of vision, lack of peripheral vision could have implications for flashing warnings.
|At Frequency (kHz)/Age Group (Males/Females)||Young Normal (20 y M)||55–64 years||65–74 years||75–84 years||85+ Years|
- Perceiving beeps or alarms that reside above 2 kHz.
- Perceiving low amplitude beeps or alarms.
- Discriminating acoustic cues that are short in duration.
- Perceiving verbal feedback that is not clear and reasonably paced.
- Trying to localise sounds.
3.1.3. Touch Sensation
- Attempting to manipulate small interface components such as buttons, knobs, levers and battery compartments.
- Perceiving stimuli such as vibration feedback.
- Distinguishing between tactile gaps, bumps and surfaces.
3.2. Psychomotor Performance
3.2.1. Hand Functionality
|Component||30–34 years||55–64 years||65–74 years||75–84 years||85+ years|
|Power Grip Strength (D)||33.8||30||27.5||22||16.9|
|Power Grip Strength (ND)||32.6||29||27||21||16.7|
|Pinch Grip (D)||6.9||6.8||6||4.8||3.1|
|Pinch Grip (ND)||6.7||6.5||5.75||4.2||2.8|
|Grip Strength||Main grasping grip||Hand Dynamometer: 3 trials||Older subjects hand grip was 30% weaker (p < 0.001)|
|Maximum Pinch Strength (MPF)||For picking up and holding items||Load cell which measured forces between 0–50 pounds||Older subjects MPF was 26% lower (p < 0.05)|
|Pinch Force Steadiness||Ability to maintain a sub maximal grip for a prolonged period is important for the manipulation of and interaction with everyday objects||Subjects asked to use the load cell to maintain forces at 5%, 10%, 20% of their MPF for a set time||Older subjects were less able to maintain a steady force and their results showed more fluctuations|
|Precision Pinch Steadiness||Steadiness of the hand while an object is held in the pinch precision||Holding a probe in holes of various sizes the subject was asked to hold the probe without touching the sides of the hole for 20 s. Errors were recorded||Elderly men made 10 times as many errors as younger men (p < 0.001) while elderly women made 22 more errors than younger females. This shows a large decline the ability to hold in place a steady pinch|
|Hand eye Coordination/Hand Dexterity||The ability to coordinate hand movement and the movement of the individual fingers in the necessary configuration to complete tasks||Using one hand, the subject picks the pegs up off the table and places them into the holes on the board, starting with the top left hand hole and completing the board on a column by column basis. This is timed to completion.||Older subject needed 19% more time to complete the peg test (p < 0.001)|
|2 Point Discrimination||The minimal interstimulus distance required to perceive two simultaneously applied skin indentations as two distinct stimuli. Important for tactile feedback during interaction.||A 2 point aesthesiometer is placed on the index finger and the subject is asked whether they can feel one or two points. The variable is the minimum distance between the two points at which the subject can discriminate two distinct points.||Older subjects needed twice the distance to discriminate the two points of the aesthesiometer (p < 0.001)|
|Movement||16–30 Years||60–69 Years||70–79 Years||80–89 Years||90+ Years|
3.2.2. Arthritis and Hand Anthropometry
|Gender||5th Percentile||50th Percentile||95th Percentile|
|No Dexterity Impairments||Male||45||52||59|
- Pressing buttons which require a deal of force that exceeds the capability or comfort of the user.
- Attempting to press buttons which are close together or are small in surface area.
- Gripping heavy or cumbersome objects, particularly in one hand.
- Attempting to reach with the thumb across an interface to manipulate controls when holding a device in one hand.
- Making certain gestures when interacting with touchscreens (i.e., pinches and swipes).
- Attempting to attach a device component with one hand without supervision (i.e., cuff on a blood pressure monitor).
3.3. Cognitive Performance
- The display and interface is cluttered or overly complex.
- Feedback is not presented clearly or intuitively.
- There is no adequate labelling or instructional support.
- Manipulating controls gives unexpected results.
- They are asked to remember difficult or complex operational routines.
|Cognitive Process\Age Group||45–49||50–54||55–59||60–64||65–70|
4. Design Approach and Design Specifications
4.1. Design Approach for Connected Health Devices
|Design Stage||Description||Example of approach to use for connected health devices|
|1 Conceptual Design||The concept for the design is proposed with few decisions made about the embodiment of the device||Ethnographic research to observe users in their own environment performing analogous tasks to that of the planned product|
Focus groups and interviews with users to elicit intelligence about their needs for a planned device.
User diaries where they record notes on a daily basis about their current experiences of a medical condition or the treatments/monitors they use
|2 Formalisation||The idea becomes more formal with decisions being made on technical features and functionality. The opportunity for design changes reduce considerably.||Heuristic checklists for good design of interfaces for older users|
Usability tests (e.g., think aloud protocol) with low fidelity prototypes of the device.
Participatory design where users give input on their preferences for the device.
|3 Design||The design is finalised and a plan is made for the product development.||Formal usability tests in a lab environment or preferably in the users home|
|4 Prototyping||Virtual prototypes from CAD models are converted to physical prototypes using 3-D printing or other methods for testing. Only critical changes to the design are often accommodated at this point, especially if tooling has been commissioned.||Usability testing with near identical models of the device. Interfaces might be replicated using off-the-shelf technologies.|
|5 Commissioning||The final design is produced and released on the market.||Few if any features can be changed at this point. It might be possible to change software through online updates.|
|6 Operation and Maintenance||The device is in use and supported by the manufacturer (if necessary).||Ethnographic testing of the current device to feed into the next generation of the device.|
- Early Focus on Users: Designers should have direct contact with intended or actual users via interviews, surveys and participatory design. The aim is to understand users’ cognitive, physical, attitudinal, and anthropometric characteristics—and the requirements of the jobs they will be doing.
- Integrated Design: All aspects of usability and human factors (e.g., user interface, help system, training plan, and documentation) should evolve in parallel, rather than be defined sequentially, and should be project coordinated.
- Early And Continual User Testing: The optimally feasible approach to successful design is an empirical one, requiring observation and measurement of user behaviour, careful evaluation of feedback, insightful solutions to existing problems, and strong motivation to make design changes.
- Iterative Design: A system under development must be modified based upon the results of behavioural tests of functions, user interface, help system, documentation and training approach. This process of implementation, testing, feedback, evaluation, and change must be repeated iteratively to improve the system.
4.2. Design Specifications
|Device||Display Type||Main Characters (h × w)||Approx. Font Size (pt)||Secondary Characters (h × w)||Approx. Font Size (pt)||Margin/Header Characters (h × w)||Approx. Font Size (pt)|
|Omron MIT Elite (Blood Pressure Monitor)||LCD Black and White||20 × 12||56||12 × 8||34||1 × 2||3|
|Omron HJ-720ITC Pedometer||LCD||4 × 2||11.3||-||-||-||-|
|Spirodoc Spirometer||LCD Backlit Touch screen||4 × 4||22||-||-||-||-|
|Prodigy Autocode Talking Metre||LCD||22 × 7||62||-||-||2 × 1||6|
|Gentle-Temp from Omron||LCD||8 × 3||22||-||-||-||-|
|ChoiceMMed Pulse Oximeter MD300C21||Dual colour OLED||7 × 4||20||-||Na||2 × 2||6|
|HCG-801-E from Omron (ECG Metre)||Graphic LCD high resolution screen with backlight||4 × 2||11.3||-||-||2.5 × 1||7|
4.2.2. Character Size
|Distance of Display from Eye (mm)||Height of Lettering||Approx. Font Size||Width of Lettering|
|Up to 500||2.5||7||1.875|
|501–900 (Typical arm length)||5||12–14||3.75|
|Age||Bright light high contrast||Font Size||Bright light low contrast||Font Size||Dim light low contrast||Font Size||Glaring light low contrast||Font Size|
4.2.3. Touchscreens as Displays
|Device||Main Button||Button Area||Secondary Buttons||Button Area|
|(h × w mm)||(mm2)||(h × w mm)||(mm2)|
|Omron MIT Elite (Blood Pressure Monitor)||16.5 × 41 (power)||676.5||25 × 11 (function)||275|
|HJ-112 Pedometer||10 × 8 (Mode)||80||8 × 6 (Memo);
4 × 4 (set)
|Spirodoc Spirometer||27 × 7 (Power)||189||na||na|
|Prodigy Autocode Talking Metre||10 Diameter (Power)||78.5||na||na|
|Gentle-Temp from Omron||15 × 20 (Power)||300||na||na|
|ChoiceMMed Pulse Oximeter MD300C21||5 mm Diameter (Power)||19.25||na||na|
|HCG-801-E from Omron (ECG Metre)||10 Diameter (Power)||78.5||6 × 10 (Side Function)||60|
|Button Characteristic||Least Required Value|
|Surface Area||110–175 mm2|
|Surface Area (for an emergency button)||700–1250 mm|
|Travel (distance button must be pressed to trigger function)||3–10 mm|
|Spacing Between Buttons||20 mm|
|Force Required for Operation||2.5–5 N|
4.2.5. Audio Feedback
4.2.6. Module Size
|Device||Module Size (hXwXd)||Weight (g)|
|Omron MIT Elite (Blood Pressure Monitor)||157 × 74 × 34||270|
|Blood Glucose Monitor||96 × 52 × 22||55|
|Pulse Oximeter||58 × 32 × 34||28|
|Pedometer||73 × 47 × 17||35|
|Spirodoc Spirometer||73 × 53 × 16||116|
|Weighing Scales||101 × 48 × 16||2870|
|GentleTemp||94 × 45 × 58||50|
|HCG-801-E from Omron (ECG)||121 × 67 × 24||130|
4.3. Design Recommendations Summary
|Screen Type and Screen Lighting||Low quality LCD screens will often display dull tones and have extremely narrow viewing angles, making it hard for a user to see details on the screen if they are looking at them off centre. This can be avoided by either increasing the screen size or installing higher quality LCD and OLED screens in devices, allowing sharper detail and wider viewing angles.|||
|Colour||The effects of ageing on colour vision perception may significantly diminish the visual effectiveness of certain colour combinations. Make critical elements larger and ensure that they have high luminance contrast with their surroundings.|
Warnings should not be solely dependent on colour, but also on visual cues such as flashing, labelling and positioning.
|Character Size||With the advent of touchscreens, adjustable text size will become the norm. Our recommendation is that character size should not go below 12 pt on a High Contrast screen interface.||[21,71,72]|
|Button Surface Area||Designers should aim for button sizes which allow for easy visibility and easy manipulation. Button surface area should typically reside above 150 mm2||[72,75,78]|
|Required Button Press Force||[5,72,75]|
|Touchscreen||Touchscreen are a more intuitive way of interacting with a display, but poor quality touchscreens are no substitute for good buttons and as such designers should be wary of introducing a touchscreen just for novelty sake. The touchscreen has to be of good quality in order to prevent user frustration and has to have a big enough screen size so as to allow for adequate spacing between elements. It has been shown that older adults can interact effectively with touchscreen interfaces.||[73,74]|
|Spacing Between Buttons and Touchscreen icons||[74,75,76,78]|
|Audio Output and Feedback||It is recommended that important auditory feedback reside in the range of 500–1000 Hz with adjustable volume level. When designing tones, beeps and alarms the ATH at each frequency must be taken into account for each age group. It is not just a case of making sounds louder, but also taking into account the frequency at which sounds are transmitted.|
If including voice feedback on a device via a speaker, the clarity of tone must be optimum otherwise users could easily misinterpret similar sounding words. Similar sounding words should be avoided when possible.
|Reducing Cognitive Load|||
- Understand and specify the context of use: We have specified a user group and analysed the context in which devices are used and how they are used. Having specified the user group, we have analysed their requirements based on quantitative data on their perceptual, psychomotor and cognitive capabilities.
- Produce design solutions: The next step is to produce design prototypes based on these specifications and present them to the user in the form of user testing.
- Evaluate: Once feedback has been received, the process begins again until all user requirements have been met.
- Equitable Use: The device should provide the same means of use for all users, identical whenever possible; equivalent when not.
- Flexibility in Use: The device accommodates a wide range of individual preferences and capabilities like those identified in Section 3.
- Intuitive Use: Device interface is easy to understand, regardless of the user’s previous experience with similar devices.
- Perceptible Information: The device communicates necessary information effectively to the user, regardless of ambient conditions or the user's perceptual abilities.
- Tolerance for Error: The device minimizes hazards and the adverse consequences of accidental or unintended actions.
- Low Physical Effort: The device can be used without causing discomfort, fatigue or strain.
- Size and Space for Approach and Use: Appropriate size and space is provided for approach, reach, manipulation, and use regardless of user’s body size, posture, or mobility.
Conflicts of Interest
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