Toward the Inclusion of Women with Gestational Diabetes Mellitus (GDM) and Healthcare Professionals in the Design of Self-Management Healthcare Technologies

Gestational diabetes mellitus is one of the most common medical complications of pregnancy, affecting approximately 4% of all pregnancies in the UK. The rate of GDM is likely to increase due to a growing prevalence of GDM risk factors such as maternal obesity and advanced maternal age, leading to increasing demand for GDM clinical services. GDM is associated with serious maternal and foetal complications, including the risk of developing Type 2 diabetes later in life. These complications represent significant health problems and costs to health services in providing care and treatment. However, the risk of adverse effects of GDM can be minimised with good control over maternal blood glucose, diet, and physical activities. In recent years, technology solutions have been developed to support women in optimising GDM self-management, thereby reducing the burden on health care services. A systematic literature review was conducted to understand the barriers and facilitators of using eHealth regarding GDM self-management to explore the role of current technology in GDM management from the perspectives of women with GDM and healthcare professionals. The results showed that while various technology solutions have been developed to support the self-management of women with GDM, usability and functionality limitations have precluded their adoption. This result led to exploring the design process of these technologies and revealing a lack of active involvement of women with GDM in the design phase of GDM self-management systems. To address this gap, sixteen women with GDM and healthcare professionals participated in interviews to understand the barriers and facilitators of active involvement of women with GDM in the design process and gather their needs from a GDM self-management system. Participants also ranked desirable features (identified from the interviews) via an online survey to provide a focus for the design phase. A design method was then developed based on the findings from interviews, adopting principles of Design Sprint and Co-Design methods into the ISO user-centred design framework to support the involvement of women with GDM in the design phase. Thirteen online workshops were conducted involving five women with GDM and two women with a history of GDM, who participated in idea generation, paper-based sketching, and group discussions, followed by interviews to gather their experiences of participation. From these workshops and interviews, two sets of recommendations were developed: guidelines to support active inclusion of vulnerable participants, such as women with GDM, in the design phase; and optimising women’s involvement, engagement, and contribution during design workshops of a GDM self-management system. Further, the low and high-fidelity prototypes were developed and evaluated, by ten and thirteen participants respectively, to refine the design solution based on women's needs via iterative evaluations and to explore how the active involvement of women with GDM in the design phase impacts the perceived usability of a co-designed solution. Overall, the findings of this thesis suggest that the involvement of women with GDM as co-designers is critical in addressing the usability and functionality issues of existing systems.