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Our initial assignment was to provide as much support and suggestions as possible as well as to hopefully aid in the interface design process. As Sydney and Rakpong’s project is composed of a large portion of interface design, they felt it was important to do a majority of the interface design themselves. Our role thus changed to one focused more on evaluation and consulting when given the opportunity. Our project will focus on these aspects and our final goal is to provide a set of informed and meaningful suggestions based upon Norman’s principles and Nielson’s heuristics set within the context of user centered design. Unfortunately we cannot perform a full evaluation as many of the device’s usability strengths and weaknesses are manifested within the physical form of the device as a whole and within the interaction with smaller design aspects such as the way a cap is highlighted by color or the manner in which it is snapped off or pressed. We will instead attempt to make suggestions using the context of our product design background.

According to Wikipedia and its linked sources, Multiple Sclerosis is characterized by the degeneration of the Myelin sheaths which protect brain and nerve cells. When the body attempts to rebuild the damaged material, scars known as scleroses or lesions, develop. As this is a neurodegenerative disease, the manifestations of the degeneration vary widely. There are four primary progression patterns of the disease which determine the patient’s treatment options and quality of life. In several of these exists a sub-pattern of relapsing attacks. In some cases these relapses can be subdued with the use of one of five drugs which are either administered orally or through injection. While these do not reverse the affects of the disease they can extend the lifespan of someone suffering with MS.

What is ALLY ALLY is an injection management concept created by Sydney Minnis, and Rakpong Songpitak. Several of the leading treatments for Multiple Sclerosis cause damage to the tissue surrounding the injection site. Sydney and Rakpong also say that administering injections in the same location can be life threatening. These factors create a need for accurate injection self-regulation. Unfortunately

there are several difficulties associated with self-administering shots of this nature. This includes lack of sufficient dexterity when manipulating a syringe, the nature of repetitive medication and its association with forgetfulness, and management of multiple injection sites on a complex schedule. These are all complicated by the affects of MS upon the central nervous system and the brain.

This Render and all subsequent renders created by Sydney Minnis and Rakpong Songpitak

Our initial assignment was to provide as much support and suggestions as possible as well as to hopefully aid in the interface design process. As Sydney and Rakpong’s project is composed of a large portion of interface design, they felt it was important to do a majority of the interface design themselves. Our role thus changed to one focused more on evaluation and consulting when given the opportunity. Our project will focus on these aspects and our final goal is to provide a set of informed and meaningful suggestions based upon Norman’s prin-

ciples and Nielson’s heuristics set within the context of user centered design. Unfortunately we cannot perform a full evaluation as many of the device’s usability strengths and weaknesses are manifested within the physical form of the device as a whole and within the interaction with smaller design aspects such as the way a cap is highlighted by color or the manner in which it is snapped off or pressed. We will instead attempt to make suggestions using the context of our product design background.

Initial Concept Evaluation Methods We based our evaluation of the prototype user interfaces upon four principles of Visibility of System State, Affordance, Reduction of Cognitive Load, and Restraint. With these principles in mind, we focused on ways in which the user interface could be improved without much regard to the overall form as the shape and drug delivery system was still under development. We did however provide our thoughts on which of three concepts seemed most developable. In order to make these suggestions we chose to conduct task flow analyses for each of the three concepts and provide a criticism of the suggested concept based upon our four principles. We also provide suggestions which were used to refine the final concept.

Concepts created by Sydney Minnis and Rakpong Songpitak

Box Concept We feel the box concept was very strong in several areas and also displayed some need for improvement. In terms of Affordance the box was confusing at first as it does not suggest to the consumer that it is transportable or where the injectors may come out. Nor does it convey which side or spot the injectors may come out. The box does improve upon the other designs in terms of visibility. The user can easily see what the day and status of the injection schedule are due to the clear screen and its physical size. The strongest feature of this concept relates to constraint. The device locks on days in which an injection is not to be administered. This keeps the user from accidentally giving themselves a potentially harmful dose of medicine.

Touch LCD Screen

Syringe Slots

Touch to confirm the site and the syringe will pop-out.

This concept is a syringe container featuring a touch LCD screen. The patient can schedule and program their injection sites. Therefore, they will have a more organized schedule which helps prevent injecting into the wrong location, which may results in overdose of medication.

Multiple Sclerosis Group 2

Simply refill th into the slots

Syringe Concept Concept 3

Multiple Sclerosis Group 2

Concepts created by Sydney Minnis and Rakpong Songpitak

The two part concept needs has some serious issues which must be addressed before it can be developed further. The first of these issues relates to visibility. USB is for uploading data fromto see the two vital pieces The Featuring screen too small your computer of information which make the concept of a memory device function. The user can not see the date, the location, and system status simultaneously. In terms of Syringe: This device will make sure that the patient is doing the injection at 90 degrees to the affordance, the device also displays some highly salient surface of the skin. issues. The user who may have difficulty controlling his or her fine motor functions must maneuver a syringe like device intocananother small interlocking device. This is not The patient schedule the injections and upload it to the device via USB. Locking Key immediately communicable by the current form factor and the syringe portion of the device does not improve Screen the ergonomics of the device substantially enough to Supporting Cup warrant a redesign. The device does not feature the well placed use of constraint of the box device. While the device does force a user to place the syringe into other the ondevice at a proper angle, the use of This concept the helps the patients half do theirof injections a schedule. The device has a locking key that attaches to the syringe. Once put the device yourboth injection screen and docking system are theyousmall sizeon of site if it’s a different location from the screen, the key will lock the syringe and the injection will not be usable. improper implementations of this principle. While this concept does reduce cognitive load, its misuse of the previously discussed principles negates this fact. 5

Cylinder Concept The second concept was therefore the most promising. It consists of a cylindrical form factor in its concept iteration. It also displays the most consideration for the principles with which we are evaluating. It uses a proportionally large screen which allows the user to see the date, time, and location of injections as well as the simple “on or off” display features. The user can see if the device is on, if it is a day in which they need to inject themselves, and they can see where to do so. In this way the second concept follows the need for system state visibility closest. Additionally the form of a large pen or flashlight is instantly understandable by virtually any person and follows the principle of Affordance best. Both those with imperfect fine motor control and healthy functions are able to easily grasp and maneuver a device with this shape. The shape also suggests to the user the side in which the injector is located through simple visual cures. This device, like the box concept is able to efficiently reduce cognitive load through locating all contextual information related to self-administered injections within the easy to view screen. The only principle in which this device fails is its use of constraint. In this case this type of constraint can also be described as unnatural mapping. The device does not lock itself on off days. It would possible for a person to accidentally inject themselves on the wrong date or area due to this. Additionally the unnatural mapping of up and down buttons is confusing and poorly communicates

Concepts created by Sydney Minnis and Rakpong Songpitak

Concept 2

Auto - Injector

T m i W m y i

Syringe Container

Schedule Adjustment Bottons

LCD Screen

The screen helps remind the patient to take the medication on the correct location.

Artery Sensor

the function to the user. The system also constrains Multiple Sclerosisthe Group 2user to choosing confusing sets of menu options. In this way the user is unable to back out in the same fashion as they entered the current menu screen. When they want to choose “up” or “down” they must press a button which is either far right or central right. These buttons are oriented horizontally which violates the principle of natural mapping.

F t f t A a t n a

Initial Suggestions We chose the cylindrically shaped concept as our candidate for further development. In order to begin development we compiled a list of suggestions. 1.

Improve user control and freedom. Place a Save and Done option inside of each of the menu screens.


Instead of four buttons consisting of “select,” “back,” “up,” and “down,” place only a select button on the left side of the device and place the up and down buttons vertically on the right side. Integrate the back/done button within the screen selections.


Integrate the “lock” feature of the box concept into this concept.


Make sure the two primary bits of information “on/off” and “injection location” are immediately visible on the injector.

Final Concept Evaluation Methods At this point in the project our undergrad partners used our critiques and suggestions to develop the concept to final form. Once this concept was completed we were then able to perform a much deeper evaluation of the form and the user interface. As part of our final critique we performed a task flow analysis, and based our evaluation on: Affordance, Visibility of System State, Constraint, Reduction in Cognitive Load, and Aesthetic Representation. Additionally We performed a usability study based upon several of these concepts then averaged these results to create a more accurate understanding of the concept’s strengths and weaknesses. For our usability test we created six points of measurements consisting of four timed tasks and two rating based questions. We then created a fictional background scenario which we explained to our participants. We told them they were afflicted by Multiple Sclerosis and then explained the need for an injection schedule as well as the importance of rotating injection sites. We also told them they might have lessened motor control and finally that the doctor had asked them to change their schedule from every day to every three days. We then performed the usability evaluation. For questions involving affordance and ergonomics, a crude prototype made of two DD batteries taped together was used in order to attain better information.

All of the questions relate to affordance to some extent but they differ in their secondary correlations to our chosen evaluation criteria.

Usability Questions 1. The first question, which was timed, addressed affordance. We asked "Please locate the injection initialization button." 2. For the next timed question we asked: "Please adjust the injection schedule to every three days." This also measured affordance as well as visibility of system state. More importantly it is a basic measure of the overall ease of use built in to the interface. 3. The third timed question which correlates to Visibility of System State, and Reduction of Cognitive load, asked: "Please tell me if you need an injection today and where you need to administer the injection if you do." 4. The fourth question was a scale based metric. This relates to the same principles as question 3 but creates a measure of perception. We asked: "How easily you can identify: weather it is an injection day, and where the injection is to be administered." 5. The fifth question was also based on a scale, and relates to affordance, and constraint. We asked: "How might you pick up this deice and inject yourself on your shoulder? Keeping in mind you need to maintain a 90 degree angle between device and skin." 6. The sixth and final question posed was a scale which addressed Aesthetic Representation. We asked: "How comfortable would you be with allowing this to be seen by family, friends, and possibly acquaintances within your house?"

Usability Test Results

Results Discussion We were not able to assess any special relationship between the physical form and constraint with the usability test. Nor were we able to fully explore the reduction in cognitive load experienced when a user might use ALLY instead of a normal calendar. Despite these shortcomings we were able to see some clear trends in our results. With the current form factor and placement of buttons, participants were able to clearly distinguish the “inject� button in a mean average of 4.8 seconds. This was remarkably quick considering the participants had not seen the concept for more than a minute before the question was posed. This shows that this button

was clearly marked and its function was easy to understand as important. The third question also displayed positive results. The participants were able to identify the time and location of their next injection in a mean average of 6.7 seconds. This reinforces the hopes that ALLY would be a device capable of reducing cognitive load through visibility of system status, good feedback, and use of good affordance. When the participants rated the ease of acquiring this information, they were equally pleased. They all chose 5 on a scale of 5 being the best. When the users were asked to pick up the device and act as if they were administering a shoulder

injection, the shape’s familiar shape also proved to be very beneficial. The participants all picked the shape up as if it were a pen then switched to a flashlight-like grip but almost immediately switched to back to a pen-type grip with thumb on one side and index finger on top. The last question which dealt with Aesthetic Representation and ultimately the reduction of negative connotation and stigmatization, was equally well scoring. The participants gave their willingness to openly display this device a mean average of 4.3 out of five. Considering current alternatives are a syringe and a calendar with large salient text, this is a dramatic improvement in usability and user centered design. According to the results there also exist several areas which are open for improvement. The users required a mean average of 51 seconds in order to adjust the frequency of the schedule. Additionally the act of twisting the top in order to move the selector was very unnatural for the participants. They were unsure of how they must choose and select the different screens and options. When asked to identify the injection button it was also very obvious post-test, that the close proximity of the injection button is confusing and possibly dangerous for such a device. The two most important principles for this device to excel in remain reduction in cognitive load and proper and considerate aesthetic representation. Fortunately for the current iteration of the ALLY concept, the results proved very positive in these aspects.

Evaluation of Implementation of Previous Suggestions. The new design is quite successful in interpretation of our initial suggestions and even more so in building upon these suggestions to create a better product. The button layout is completely redesigned and the graphically presented semantic information is more concise and logical. There is now only a “done� option located within the UI. This is very simple and effective. While we did not explicitly suggest that the device remain continually able to communicate system status and on-day/ off-day information the undergrad team did a great job of creating a much more successful concept with these additions. The shape of the device was refined and improved both aesthetically and ergonomically. We are happy the team chose to pursue the cylindrical form factor.

Heuristic Evaluation Affordance Krug’s Principle of Don’t Think remains our overarching theme and litmus test against which we are evaluating ALLY. To this end, consideration for Affordance, intentional or not, has been one of the strongest aspects of ALLY. The device’s simplicity in user input and physical form allows it to quickly and easily convey the important information required for simple use to the end user. The final concept’s form built upon the early concept formed by a cylinder. The new form is contoured to better fit the hand when being used as a handle shape and pen shape as the area of grip for a pen-type grasp is narrow enough to be effective. Reduction in Cognitive Load The second way in which ALLY’s interaction makes it an improvement over a calendar is its ability to display only the necessary information and reduce the need for a user to think about any other contextual information. When looking at a calendar the user might have to remember what area to look on the calendar, then ensure that they properly marked the previous date and that the entire calendar month is filled in correctly. They must also look in the middle of much information which is essentially auxiliary as it has already been used to make proper injection schedule decisions. When looking at ALLY the user simply has to look to see if the injection day indicator is green or red. There is no other necessary information required to

make an informed decision as the device automatically records and calculates this information. The interface itself is shallow and narrow enough that the extra cognition required to operate it is far outweighed by the overall simplicity of the device in comparison to a calendar. Aesthetic Representation The last of the major improvements of ALLY over a calendar is manifested in its ability to display the required information in a much more subtle and attractive manner in comparison to its paper counterpart. This is a very important consideration in every day use and overall happiness with a device. Visibility of System Status Ally is also successful low cognition device as it always displays the weather it is on or off and weather or not it is a day for injection. This specifically makes the device incredibly simple and competes with the simplicity of marks on paper without all of the extraneous confusing information nor other drawbacks. Within this principle lies the factor of good and immediate feedback. This device improves its visibility by immediately displaying the status of the injection as a green and red light post-injection. This drastically reduces the likelihood that a user might forget he or she gave themselves an injection earlier in the day. This form of forgetful mistake can become extremely simple to perform after months of a repetitive action.

Constraint The final principle that makes this concept beneficial is constraint. The device is able to improve safety and ease of use especially in error prevention and recovery through a locking mechanism. This mechanism is turned on whenever the device is in an “off� day or date. Additionally it works in conjunction with immediate feedback to stop the user from injecting themselves twice without a highly salient disruption in routine. The user must go into settings and reset the system in order to administer an injection when he or she should not. This also improves safety and ease of use.

Criticisms Unfortunately there are some negative aspects of this device’s interaction. The most dangerous and highly visible problem in design is the proximity of the inject button to the select button. They are close in proximity, size, and form. A person without the ability to maintain direct eye contact with their hands could easily misplace a finger and accidentally press the select button or even worse, prematurely administer a dangerous dose of medicine. Though the device does not activate without contact with skin, this error in interaction could cause the user to inject themselves in the wrong place or drastically increase frustration in every day use. In terms of affordance there also exists a major design error in the similarity between end cap and injector cap. The two ends look nearly identical and the end with color differentiation is actually the container end. This simple switch is confusing and the similarity between ends could cause great

confusion and frustration throughout the lifespan of the device. The device also contains a major problem in its up and down button selector. In tests the most confusing aspect was the twist action and identifying this end as the control mechanism. During usability tests the users had to be reminded several times that this was the input area. The red and green LED also is an example of a improper application of high visibility. If the device were located in the same spot in a home or worse kept in a purse or bag, this LED would prove far too small to achieve its intended function. Haptic feedback could also be improved. The cylindrical shape which works so well when considering affordance, fails in providing enough orientation feedback to the user when visual feedback is not available. A situation in which the device becomes flipped end to end could easily happen when injection in the shoulder area. After this happens the slight indent around the inject button could become hard to find and the user would have to return the device to their direct line of sight.

Final Suggestions With several small adjustments to the interface, ALLY could become a highly usable product as well as a highly functional and beneficial product. Below we highlight a list of suggestions which we hope will improve usability. 1. Create a much larger “On day/Off day” indicator light or system. This must be much more salient in many lighting conditions and environments. 2. Indicate the “select” button with a symbol or some other designation to reduce initial confusion. Place this symbol near current advisory text inside the main menu screen. 3. Move the inject button to a new location or integrate it into the current menu based UI as the buttons are too similar in form and location in their present design. 4. Differentiate between ends. Make the injector end the most salient as this is the functional end of the device. 5. Add up/down indicators or arrows to the twistable top control input. Additionally reconsider this twist action and possibly look into more standard buttons to accomplish this task as it is more natural and understandable.

6. Create a divot in the current injector end cap to convey to the user how to best open this cap area. 7. Consider removing the cap altogether and storing the injector tips inside of the device. A sliding automatic door could also be functional in this area. This cap creates an unnecessary and potentially ergonomically difficult step between evaluation of injection necessity and execution of this goal. 8. Add some type of texture along the device to improve haptic feedback during injection when visual feedback is not available. 9. Reword the location menu screen and preferably add more information in the form of text or visuals. 10. Improve saliency of selection actions within the UI. Currently the text switches colors but this may not be enough considering the users have neurodegenerative disorders. 11. Add warning screen or feedback between unlock actions and access to settings on off days. Additionally add a warning after pressing the injection button on off days.

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