2015 IEEE 2015 International Conference on Computer, Communication, and Control Technology (I4CT 2015), April 21 - 23 in Imperial Kuching Hotel, Kuching, Sarawak, Malaysia
i-KS:Composition of Chronic Kidney Disease (CKD) Online Informational Self-Care Tool Arifah Fasha Rosmani, Umi Hanim Mazlan, Alif Faisal Ibrahim, Dina Shamila Zakaria Department of Computer Science Universiti Teknologi MARA 02600 Arau, Perlis
[email protected] healthy, they need to have the knowledge about this disease and also have to be more health conscious. Therefore, these patients need very decent guidelines that can aid them to monitor their health as well. CKD patients should know about their health numeracy well, which describes an individual’s ability to understand and know the detailed amount as they are related to health such as interpretation of test results, calculation of dosages, and understanding of dietary portions and nutrients. Besides that, for the CKD patients who were using dialysis treatment, they need to be more conscious about their healthy lifestyle, such as the amount of water needed in their body and the consequences that need to be cautioned. In addition, by integrating multimedia design principles and multimedia elements in this guideline, it can help to enhance the patients’ knowledge with CKD and also make it easier for them to understand. The guidelines for CKD patients are vital to ensure they know how they can survive their daily life, just like healthy people. Therefore, an effective guideline can help CKD patients in their self-care management. Self-care means you take responsibility of your own health and wellbeing, while receiving support from the people involved or not in your care management [2].
Abstract— Chronic kidney disease (CKD) is a chronic condition where the kidneys’ functions’ progression is lost or slowed in the body. Once our kidneys are damaged, excretion process in the body cannot be carried out effectively. Important information is needed for CKD patients such as food nutrition, consequences and also daily healthcare management. Thus, the focus of this project is to develop a multimedia application for CKD patients that can provide self-care guidelines for their daily life. This project is developed using Adobe Flash CS5.5 that provides the outcome which is CKD patient self-care guidelines flash tool. Subsequently, a simple website of CKD patient self-care guidelines has been developed using Adobe Dreamweaver that acts as a tool to disseminate this multimedia application. From this project, a new interactive design of CKD self-care management has been created and more effective information channel is developed for them. Heuristic evaluation and usability test have been conducted on the experts and real users to ensure that the project delivered meet the users’ expectations. Keywords-Chronic Kidney Disease; Self-care; Multimedia; Courseware
I.
INTRODUCTION
Chronic kidney disease (CKD) is a long term condition where the kidneys do not work effectively and cannot function well to filter out our blood and remove waste products from the body. CKD includes conditions that damage your kidneys, thus reducing the ability to do daily activities. Usually, a person with CKD does not indicate any visible symptoms until he or she reaches the advance stage. However, but it should be detected at an earlier stage by screening test to prevent any other consequences. If you are at a high risk of developing CKD you may need to be screened manually. Screening is recommended if you have high blood pressure or hypertension, diabetes or family history of CKD. The main symptoms of advanced kidney disease includes tiredness, swollen ankles, feet or hands due to water retention, shortness of breath and nausea. Most people do not realize any of the symptoms because the body can tolerate even a large reduction in kidney function [1]. Having chronic kidney disease means that for some time your kidneys have not been functioning normally. Once your kidney is damaged, it will slow down the progression to filter the blood and remove all the waste or dangerous substances from your body. Ideally, to ensure that CKD patients stay
978-1-4799-7952-3/15/$31.00 ©2015 IEEE
II.
SCOPE AND SIGNIFICANCE OF RESEARCH
This study undertakes to assist CKD patients in their selfcare management in this country. It has been reported in [3], there are a total of 25,000 kidney disease patients and the number is on the rise with 4 to 5 thousand new cases per year in Malaysia. The purpose of this study is to provide the knowledge about the self-care management of CKD patients as well as for those who are at risk of kidney disease. The scope of this study also provides the information needed for the CKD patients and discloses all the knowledge and consequences about this disease to them. Previous studies have suggested that the quality of life (as measured by utility) of people with CKD is higher in those with a functioning kidney transplant, rather than those on dialysis. However, currently, it is unclear whether the type of dialysis affects quality of life. Hemodialysis is a highly technical process that directly filters the blood, usually must be done 2-4 times a week, and can only be performed in a health facility [4]. Usually, CKD patients tend to choose to do a
379
C. Comparison Study
dialysis treatment rather than kidney transpplant because it is difficult to find a suitable kidney donor foor them. So, when they choose to do a dialysis treatment their health care management should be monitored thoroughlyy. III.
1) National Kidney Foundaation of Malaysia This website provides some knoowledge and information that all the CKD patients need to know w. Besides, all the news such as events that will be held for CK KD patients will be announced in this website. Based on the obseervation, this website is not very interesting to be used because the way they present their information is too complicatedd. The nature of the text really makes the users feel tired to read and the interface is also very attractive and make the users lose l their desire to discover the website further. 2) The Renal Association The Renal Association has deveeloped their own website to help CKD patients enhance their knowledge k and provide all the related information. The Renaal Association is a professional body for United Kingdom nephrologists n and one of their objectives is to collect all the information and disseminate all t disease and also to engage the related knowledge about this with any matters concerning thhe CKD patient healthcare. Most of the important information has been put on this website. However, the information is tooo comprehensive because they need to read a lot of sentences to make them understand. Thus, the knowledge level of this disease d among the patients will remain low because the inform mation delivered to them cannot be accepted effectively. 3) Australian Diabetes Couuncil Australian Diabetes Counncil also develops their own website by providing the inform mation and guidelines to diabetic patients and to help them too monitor their health as well. Australian Diabetes Council is an organization that focuses on providing support and servicce to the all diabetic patients internationally and nationaally. Membership with this association gives an opportunitty for them to get all the services provided by this association suuch as consultation with all the members to make a positive change c of life living as diabetic patient. This website seems like an interesting website because it also provides suggestions on recipes for the diabetic patients together with the nutritional information. Besides, this website also provides some videos aboout diabetic patients’ history to attract the users and allow them m to learn from the patients who had suffered this disease. Howeever, this website performs their information about the diabeticc also filled with a lot of words without any interesting picturess or sounds, so will reduce users’ desire to learn more.
RESEARCH BACKGROU UND
A. Chronic Kidney Disease (CKD) Chronic kidney disease (CKD) which is also known as chronic renal disease is loss or slow proggression of kidney function within a few years and eventuallyy the patient will remain alive with the kidney failure [5]. CKD D has been a major disease in the world when the number of patients increases every year with age and it also causes variouus negative effects on the quality of life. Some patients do nott realize they have this disease because they did not experience any a symptoms. It was really worrying when the numberr of mortality rates due to this disease increase year by year althhough a patient has undergone dialysis for five years and above [6]. [ CKD is known as a ‘silent killer’ because it shows some syymptoms either we realize them or not and can be fatal if allowed undiagnosed or untreated. The symptoms include tirednesss, fatigue, swollen breadth and swollen in any parts of the bodyy, especially on the hands [7]. Mostly, CKD patients are diabetees or hypertension patients but they never expect to have this dissease despite being healthy every single day. It was really terrible if the patients do not realize that they have kidney diseasee because it was uncommon for their kidneys to fail to funcction without them noticing it [8]. B. CKD Self-care Self-care or self-management is a populaar term that is used especially for the management of chronic connditions or chronic diseases [2]. It is defined as espouse in treatm ment and education to acquire the outcomes, help people maanage their health condition on a daily basis. Besides, it also can assist people with the competence and ability to reducce all the illness impacts with or without a healthcare teaam to help. Selfmanagement for the CKD patients includes all a the tasks related to them that are significant for them to havee a good quality of life while living with this chronic disease conndition. The tasks needed are role managemennt and emotional management [2]. These tasks are necessaryy to help them to manage their daily life as well as to get a better view of their life despite suffering this chronic disease condition. Besides, self-management is needed to help them to manage m this disease really well. Successful CKD management rellied heavily on the patients’ self-management efforts and theirr responsibility to their selves rather than depending on healthhcare management [2]. Patients’ self-management must be able to enhance the patients to gain the skills and confidence to allow them to manage themselves in everyday life. Sufferring the CKD will not hinder the patients to have a better quallity life as long as they know how to overcome this disease in the right way. D cannot be cured Based on what we deliberated above, CKD and the patients will not fully recover from f this disease. However, we can slow down its the progrression instead of letting it to get worse.
IV.
METTHODOLOGY
There are a total of three main phases involved in this 2 development and 3) testing. study, which are:1) design, 2) Howerver, in this article, the most m important phase which will be highlighted is the developm ment phase which includes the application architecture. The phases p are as shown below in Figure 1.
Design
380
Deevelopm ent
Testing
Figure 1: The main phases involved in this project.
memorability, errors and satisfaction [10]. Usability testing is an essential aspect that needs to put users as the priority in making any interface design decision. This testing method involves real users attempting real tasks. According to [13], there are four key factors that must be used in conducting the usability test, which are, using real users to test the product or design, users must do real tasks, the researcher or designer observes and records what the users say or comment and then, analyzes the users’ comments, determines the problem that may occur and recommends the changes to fix the problem. In other words, usability testing is a method where users test a product and determine and inform any usability problem during the development process, so that the problem can be rectified before the final product stage. 2) Heuristic evaluation Heuristic evaluation is defined as the expert reviewers’ critiques and comments on the interface design to determine its conformance to a list of design principles which is heuristic design and interpret the design which does not follow the design rules. Heuristic evaluation is also a review of the product by usability specialist and against a list of general guidelines. According to [11], this method is cheaper compared to other evaluation methods and it is also easy to motivate potential reviewers to use this method. It can also be used at the early development stages.
A. Design In the design phase, the interface and the content of the project must be designed first before it can be developed. There are two steps that have been carried out in this phase, which are designing multimedia application for CKD patient self-care guidelines then, designing a simple webpage for CKD patient guidelines. Besides, an animation character, “K-ney”, is also designed in this phase. Storyboard method is used in this phase to sketch the interface for both steps. Storyboard is a graphic organizer that provides the audience with high-level pictures of a project. Using storyboard helps designer to understand easily the cases and the situation because the way to create a storyboard is by combining all the various elements such as behaviors, requirements and the solution [9]. In this phase, there is a need to illustrate and sketch the project sequence in order to demonstrate the design. In this project, the storyboard includes design for CKD Self-Care Guidelines Flash Tool and interface for CKD Self-Care Guidelines webpage. The outcomes of this phase are the complete sequence of the project development.
V.
APPLICATION ARCHITECTURE
i-KS application was developed with four main menus which are Introduction (to kidney and kidney disease symptoms), Effects (for kidney patients), Healthcare (diet, precautions and activities for kidney patients) and Quiz.
Figure 2: Storyboard
B. Development Development phase can be defined as a key step in the project methodology. To ensure the success of this phase, the product development should meet the design specifications and the product construction was constructed in a proper process using the selected tools. In this project, the multimedia application was developed using Adobe Flash CS5.5 then the webpage of CKD Self-Care Guidelines was developed using Adobe Dreamweaver. The integration part has taken place after both multimedia application and the webpage were completely developed. CKD Self-Care Guidelines Flash Tool was integrated into the webpage and a simple webpage was created as a tool to disseminate this multimedia application and finally, a complete CKD Patient Informational Self-Care Prototype was completed.
Home
Intro
Learn about your kidney Kidney functions Kidney disease symptoms
Effects
Healthcare
Quiz
Diet
Activities
Precaution
Recipes
Food to eat less
Food/Nutrition information
Figure 3: Application Architecture for the i-KS application.
A. Home The main menu of this application is the home page that comprises four main menus, which are: 1) Intro, 2) Effects, 3) Healthcare and 4) Quiz. 1) Intro Intro page introduces users to some general knowledge about kidney disease. In this page, users will be shown the kidney functioning in our body. Then, three main kidney functions will be shown to the users and how these work in our body. Users can control some animation that was created in this application such as the press play button to play some animation on this page.
C. Testing There are two different types of testing that must be conducted in this project, which are usability test and heuristic evaluation. 1) Usability test Usability means a quality on how easy the user can assess the user interface to be used and it can be defined by five quality of components which are learnability, efficiency,
381
that are allowed for them to conduct. Diets button will provide the users with some information about their food that they are allowed to eat. This page gives users some food information that is really important for the patients to know. Kidney disease patients really need to be cautious about their food intake because a lot of harmful effects may occur because of it. However, for Eat Less page information provided is about the potassium intake only, because as we know, kidney patients are not allowed to take too much of potassium every day. Therefore, this page only highlights the potassium intake in its food nutrition info. Besides, this page also provides some suggestions of recipes for them to try.
Figure 4: Introduction - Learn About Your Kidneys
The page as shown in Figure 9 allows users to know the main function of our kidney in the body. In this page, users can see a simple animation on how the kidney separates or filters waste product to be excreted from the body. As an additional information to the users some of the symptoms of kidney disease that are usually experienced by the patients. 2) Effects In this page, users can know the effects of kidney disease to the patients. There are several effects that may occur. They can choose the effects they want to see by pressing the button provided in this page.
Figure 7: Diet - Recipes
Figure 8: Healthcare – Activities
Figure 5: Kidney Disease Effects
Activities pages provide users with some activities that are suitable for the kidney disease patients. They can actually go fishing, cycling, gardening and walking to maintain their fitness.
3) Healthcare Healthcare page contains three subtopics that can be chosen. In this page, three buttons represent precautions, activities and diets. All these three buttons will bring the users to the more attractive and interactive pages. Precautions button will bring users to its page, which will tell more about some precautions that the patients need to be aware of. For example, there are some other diseases that may cause kidney disease such as high blood pressure, diabetes and asthma. This page will provide some health care information on how to maintain their blood pressure and sugar level in the body and also some precautions for asthma. Then, for the activities page, users can see and get to know some activities that are allowed for them to do.
4) Quiz Users can test their understanding regarding the content in this application by answering some questions provided in this page. They are at the end of this application as a simple quiz to motivate users in understanding all the significant contents in this application.
Figure 9: Quiz Section
VI. Figure 6: Healthcare – Precautions
USABILITY TEST & HEURISTIC EVALUATION RESULT
There were two types of testing that had been performed, Heuristic Evaluation and Usability Test. There were 20 participants involved in this testing which included kidney
Some animation was added in this page to make it more interesting to be watched. There are several simple activities
382
patients, their family members and nurses. Results are as indicated in the details below.
the patients agreed that this appplication can help them in their daily self-care management. The advantages of this coourseware are derived from the observation and performance thhat have been carried out during the development of the applicattion. The advantages are: i-KS gives users a new sim mple application to improve their knowledge about Chronic Kidney K Disease. i-KS can assist Chronic Kidney K Disease patient in their self-care management. i-KS is a user friendly appplication and easy for patients to navigate. i-KS is an interactive appplication that can attract users’ attention to learn more.
A. Usability Test Usability testing is necessary for interfacees and interactive products or projects. By using this methodd, it is possible to identify the major problems or issues in usability and collect feedback on the subjective aspects of usability u such as satisfaction and aesthetic appeal.
REFER RENCES [1] Kidney disease, c.-S.-N.C.; Available from: http://www.nhs.uk/Conditiions/Kidney-diseasechronic/Pages/Symptoms.aaspx. [2] Ong, S.W., Jassal, S. V,, Porter, E., Logan, A. G., & Miller, J. a., Using an elecctronic self-management tool to support patients with chrronic kidney disease (CKD): a CKD clinic self-care moddel. Seminars in Dialysis, 2013. 26(2): p. 195-202. [3] Chow, J. (2012) Kidney Disease D on the Rise in Malaysia, Experts Warn Public to Taake Care. [4] Wyld, M., Morton, R. L., L Hayen, A., Howard, K., & Webster, A. C., A systemaatic review and meta-analysis of utility-based quality of life l in chronic kidney disease treatments. PLoS Medicinee, 2012. 9(9). [5] Nordqvist, C. Chronic Kidney K Failure. Medical News Today 2014 [cited 2015 25 2 February 2015]. [6] Collins, A.J., Gilbertson, D. D T., Snyder, J. J., Chen, S.-C., & Foley, R. N., Chronnic kidney disease awareness, screening and prevention: rationale for the design of a public education program m. Nephrology (Carlton, Vic.), 2010. 15(2): p. 37-42. [7] Graaf, M.d. (2013) Kidneyy disease - the ‘silent killer’ that is posing a huge health rissk. [8] Joe Balintfy, V.C., Alan Defibaugh, D Dana Steinberg and Harrison Wein (2013) Keep K Your Kidneys Healthy Catch Kidney Disease Earrly. [9] Crothers, B. (2011) Storyyboarding & UX – part 1: an introduction. [10] Bevan, N. (2006) Heuristicc evaluation & Usability Test. [11] Nielsen, J. (2009) Heuristiic evaluation. [12] Heuristic Evaluations andd Expert Reviews. [cited 2015 Available from: 27 February]; http://www.usability.gov/hhow-to-andtools/methods/heuristic-evvaluation.html. [13] Dumas, J.S., & Redish, J..C. (1993). A practical guide to usability testing. Norw wood, NJ: Ablex Publishing Company.
Figure 10: Usability Test Resultss
Figure 10 shows that 95% of the users were w satisfied with the content in this application as unncomplicated and straightforward information, 92% were satisfied s with the navigation of i-KS as understandable and reeliable through all the application and 93% were also satisfied with the elements used in this application. Based on the overaall testing process, all the respondents favored for this application to be used as a guide to help kidney patients to manage theiir daily healthcare. They agreed that it also provides more inforrmation about this disease to them. B. Heuristic Evaluation Heuristic Evaluation is a usability enginneering method to find usability problems in an interfaace design [12]. Recommendation and ideas from the experrts are received to improve the application. To improve the appplication features and quality for future development, these are the suggestions given: • Application should be improved byy providing two languages that can be chosen by the userrs. • Improve some nutrition information and add some information regarding the precautions. • Application should be look commerciial for the use of health. VII. CONCLUSION This project, “Integrating Multimedia Design Principles for Chronic Kidney Disease (CKD) Self-Care Guuidelines” is based on the problem of health care arising among CKD C patients. The objective of this project is to assist CKD pattients in their daily self-care management. The objective is achieeved when most of
383
