Accessible Design for Diabetic Foot Ulcer Self-Monitoring: Insights into mHealth Application Design

Individuals worldwide are living with diabetes, and under-resourced communities are more at risk of complications such as diabetic foot ulcers (DFUs). Integrating technology for DFU management is effective, but a digital gap persists especially for older adults. Older adults exhibit unfamiliarity with application design which may act as a deterrent from incorporating technology into their health self-management. To address this challenge, we conducted cognitive walkthroughs and semi-structured interviews with older adults (N=12) from under-resourced communities. We sought to understand their ability to use an app that required taking images and videos, interacting with the phone's motor/vibration system, and completing a walking test. In order to explore whether com- prehension and perceived utility are due to a lapse in older adult technology understanding or flawed application design, we con- ducted a second study with tech savvy university students (N=10). While the students were able to successfully complete all of the walkthrough tasks, the utility of the app was limited by the diabetes knowledge of the participant groups. We emphasize the importance of community-based research initiatives and of designing mobile health technologies that are useful and usable to those who face the greatest disease burden.