Making sense of user interactions with the artificial pancreas
Background: The ‘artificial pancreas’ (AP) is a new treatment for diabetes which allows for the automatic control of blood glucose levels by replicating some of the functions of a healthy pancreas. The system wirelessly links a continuous glucose monitor (CGM) and insulin pump, both body-mounted, with a tablet-mounted algorithm in order to calculate and administer the optimal amount of insulin required at any given time. Following successful lab-based studies, researchers at the University of Cambridge are now carrying out research on the safety, efficacy, and feasibility of the AP system for pregnant women with Type 1 diabetes in the home setting. This research is important because of potential gaps between lab-based efficacy and real-world effectiveness – gaps which may emerge because of variations in users’ wider attitudes towards science, medicine and (especially) technology. Existing research has demonstrated the relevance of such attitudes for experiences of technology in general, but as yet little is known regarding the impact of wider attitudes on the use of personal medical devices such as the AP.
Methods: A qualitative study utilising semi-structured interviews with study participants (N=16) at T1 (pre-study) and T2 (post-study), conducted as part of an open-label randomised crossover feasibility study. Interviews were carried out according to a topic guide designed to generate data to address the following research question: how do attitudes towards technology influence user experiences of the AP? Interviews were digitally recorded, transcribed verbatim, and coded using NVivo analysis software. A thematic analysis was conducted upon the coded data, informed by organisational sociologist Karl Weick’s theory of ‘sensemaking’.
Results: Attitudes towards technology in general were found to exert significant impact on study participants’ experiences of using the AP. However, these impacts were complex and multidimensional. Some early adopters of technology in general and diabetic technology in particular found the AP study pump to be less user-friendly than their own, more up-to-date devices, leading to the adoption of more cautious attitudes towards new technology in general. Conversely, participants who had previously exhibited more sceptical approaches towards technology developed more positive perspectives through their successful use of the AP. A further important finding was the wide range of factors that participants identified as potential ‘deal-breakers’ for their continued use of the AP, ranging from data collection protocols to types of user interface.
Conclusion: In common with many new medical technologies, the AP presents users with both opportunities and challenges – opportunities in terms of improved outcomes and quality of life, and challenges in terms of incorporating new devices, systems, and treatments into everyday life. This research demonstrates the importance of a user-centred approach in terms of designing technological, clinical, and personal aspects of new medical devices and surrounding interventions. Users’ interpretations of technology, and the outcomes they give rise to in conjunction with the ‘affordances’ of technology (i.e. the actions and interactions it allows for), can be influenced, but not determined, by other stakeholders. Accordingly, the question for medicine is how to design interventions so that optimal outcomes result from participants’ own interpretations.