Using Human-Centered Design and Development to Create a Digital Sick Day Medication Guidance Application for People With Diabetes, Cardiovascular Disease, or Chronic Kidney Disease: Mixed Methods Study

Sep 30, 2026

Uploaded by Adam

Diabetes, cardiovascular disease, and chronic kidney disease carry high morbidity and care costs, while medications that reduce long-term complications can also trigger acute adverse events during illness, such as hypoglycemia and acute kidney injury. Sick day medication guidance (SDMG) may prevent these harms, but effective delivery strategies remain insufficient. The study iteratively designed and developed a digital prototype UI to deliver personalized SDMG for patient self-management, aiming to reduce preventable emergencies and improve acute-illness outcomes.

LanguageEnglish

CategoryHealthcare

FormatPDF

Pages19

Reading Time48 min

AccessFree to download

Abstract

Background

Objective

Methods

Results

Conclusions

Introduction

Clinical problem and rationale

International recommendations and evidence gap

JMIR FORMATIVE RESEARCH Babione et al Original Paper Using Human-Centered Design and Development to Create a Digital Sick Day Medication Guidance Application for People With Diabetes, Cardiovascular Disease, or Chronic Kidney Disease: Mixed Methods Study | Julie Babione 1*, MSc; Sarah Gil 1*, BSc; Chidera Okemeziem1, BSc; Taylor Palechuk2, MSc; Kaitlyn E Watson2, BPharm, PhD; Sandra Robertshaw1 ; Nancy Verdin 1, BScOT; Kerry McBrien3,4, BASc, MPH, MD; David J T Campbell 1,3,5, MD, PhD; Ross Tsuyuki2,6, MSc, PharmD, ISHF; Neesh Pannu7, MSc, MD; Matthew James 1,3, MD, PhD; Maoliosa Donald1,3, BScPT, MSc, PhD | | --- | | 1Department of Medicine, Cumming School of Medicine, University of Calgary, Calgary, AB, Canada 2EPICORE Centre, Faculty of Medicine and Dentistry, University of Alberta, Edmonton, AB, Canada
3Department of Community Health Sciences, Cumming School of Medicine, University of Calgary, Calgary, AB, Canada 4Department of Family Medicine, Cumming School of Medicine, University of Calgary, Calgary, AB, Canada 5Department of Cardiac Sciences, Cumming School of Medicine, University of Calgary, Calgary, AB, Canada 6Department of Pharmacology, Faculty of Medicine and Dentistry, University of Alberta, Edmonton, AB, Canada 7Department of Medicine, Faculty of Medicine and Dentistry, University of Alberta, Edmonton, Canada
*these authors contributed equally
Corresponding Author:
Maoliosa Donald, BScPT, MSc, PhD Department of Medicine Cumming School of Medicine
University of Calgary 3280 Hospital Dr NW Calgary, AB, T2N 5A1 Canada
Phone: 1 (403) 210 6481
Email: donaldm@ucalg[ary.ca](ary.ca)
Abstract | Background: Diabetes, cardiovascular disease, and chronic kidney disease are associated with high morbidity and costs of care. Medications can reduce long-term complications but may contribute to complications such as hypoglycemia and acute kidney injury during acute illnesses. Sick day medication guidance (SDMG) could help prevent these adverse events, but evidence for effective strategies to deliver this guidance is lacking. Objective: We iteratively designed and developed a digital prototype user interface (UI) to deliver SDMG for patient self-management. The application, called “Preventing medication complications duringAcUte illness through Symptom Evaluation and sick day guidance”(PAUSE), delivers personalized knowledge and self-management guidance directly to patients to enhance medication self-management during acute illness, with the goal of reducing preventable emergency visits and hospitalizationsand improving patient outcomes during acute illness. Methods: Using a human-centered design (HCD) approach, we conducted iterative heuristic evaluation and usability testing paired with prototype revisions. Heuristic evaluation involved our team members evaluating the prototype’s UI against established criteria. We also conducted formative usability testing with 6 patients (including a patient-caregiver dyad) to provide subjective lived experience perspectives. We analyzed data deductively and pragmatically to rapidly inform subsequent iterations. Results: We identified 21 and 44 design issues through heuristics evaluation and usability testing, respectively. The development team iteratively revised the PAUSE UI prototype between evaluations, with the final design providing key user flows and integrated supports and reminders for acting on severe acute illness situations that recommend pausing certain medications. [https://formative.jmir.org/2025/1/e77240](https://formative.jmir.org/2025/1/e77240) XSL• FO RenderX JMIR Form Res 2025 | vol. 9 | e77240 | p. 1 (page number not for citation purposes) Conclusions: Using an iterative HCD approach, we designed and developed a digital health application to deliver SDMG for patient self-management. We addressed feasible technical and workflow barriers using iterative heuristic evaluations and usability testing resulting in a refined SDMG se

FAQs

What problem does the digital sick day medication guidance (SDMG) application target?

It targets the risk of hypoglycemia and acute kidney injury during acute illnesses among people with diabetes, cardiovascular disease, or chronic kidney disease, where medications may need pausing to prevent adverse events.

How was the application designed and developed?

Using a human-centered design approach, the team performed iterative heuristic evaluations and usability testing with patients, then revised the prototype between evaluation cycles to refine key user flows and supports.

What did the study find from evaluations and usability testing?

The researchers identified 21 design issues via heuristic evaluation and 44 issues through usability testing, and the final design incorporated integrated supports and reminders for acting on severe acute illness situations that recommend pausing certain medications.

Sep 30, 2026

Uploaded by Adam