Designing Joy into diabetes apps

When was diabetes ever about joy?

How about Fun? Delight? A sense of camaraderie?

UnicornPiZero
Ha! Caught one. Pi Zero OpenAPS, via Jon Cluck & Dana Lewis (Twitter) Take a close look at this unicorn

Everyone needs a pat on the back, a Woo Hoo! and a hand to lift them up when they’re feeling down. Reassurance that we’re in this together.

As humans, we’re programmed with a need to belong. But so much of diabetes care, historically, has left people feeling alienated and alone.

I’ve been thinking lately about the interplay between design decisions,  affect/emotion and sense of community in diabetes devices. Wondering if we can do more.

One of the absolutely gorgeous things I uncovered as I was trawling through the archives of the early #WeAreNotWaiting community was a bunch of automatic messages that flashed across the screen of peoples’ Pebble Watchfaces.

There were Woo Hoo! unicorns for BGs that magically appeared to be right on target.

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Catching a unicorn! 100mg/dL

A heads up for a bit of a BG surge!

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As easy as…

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And … although I haven’t found any visual evidence yet (maybe because people didn’t post these ones?)  my all time favourite is this super geeky one when things got a bit meh!

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For BGs over 300

“You get amazing encouragement from your Pebble Watch. Who would ever have thought that?” Joanne Milo said in her 2015 video about Nightscout. Joanne has lived with type 1 diabetes for 55 years.

“When your blood sugar is at 100, a message flashes across your pebble watch saying Woo Hoo! I don’t know why this is so exciting but it is,” she said.

When I spoke with Joanne a couple of weeks ago she reiterated:

It became a joy to look at your watch

The thing that really jumps out at me about these messages is that they are supportive, full stop. Authentic and genuine. A light touch celebration in-the-moment of a shared experience. Just a flash past, not in-your-face, ever-present or intrusive. (If I’ve gotten this wrong, please let me know.)

I guess they were also of their time, and reflected the spirit of a small, supportive community.

Smartwatch and app interfaces have matured a lot over the last five years, but have we lost something of the sense of fun and community along the way? And can we, or even, should we, bring it back?

Danger Will Robinson!

Ok, so that heading gives away my age, but, moving right along…

I always get a bit nervous suggesting injecting joy into apps because people interpret this in their own way. It’s not something to rush into without appreciating the psychological and social implications of design choices. False cheer and fun/praise/moving up a level, based on outcomes, can be just another way to help people feel demoralised.

What happens when things don’t go so well? In the Pebble Watch example from the #WeAreNotWaiting community, things not going well got a surge of support too. But this hasn’t always been the case when someone decides to inject a bit of ‘fun’ into diabetes.

I’ve seen past attempts at gamification in diabetes that bothered me because it was obvious that there were reward agendas behind it. There’s an important line between coercion/control and supportive celebration. There’s also a lot of intrinsic motivation when people simply have the right tools and know what to do with them. So any affect-alerting addition to an app needs a light touch and ideally, plenty of in situ user testing.

The bad old past

In the mid 1990s a diabetes vendor in Australia started sending stickers to paediatric users of their product. Smiley faces for kids to stick in their log books for in range blood sugars. Sad faces for out of range ones. I contacted a professor in medical psychology when I heard about this. He’d written papers on learned helplessness with the advent of home blood glucose monitoring. (Learned helplessness is a precursor for depression)

The stickers were discontinued.

New apps, 2020 style

Sugarmate

The Sugarmate app, which has just been acquired by Tandem, along with its founder, Josh Juster, has a unicorn tally as part of its reports. It’s a tally of the 100s (5.5s) over a certain time period. It’s pretty cute.

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I’m partial to tiny unicorns, and this one’s tucked discreetly down into the the report grid, so I’m guessing it will be a light touch and a tickle for me if I notice it.

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But quantifying unicorns is not quite the same as ‘catching a unicorn’ as it flashes past. And my BG target is currently set at 108 (6mmol/L). Maybe it will be the artefact that convinces me to return to my previous target of 100 (5.5)? I wonder…

Happy Bob

The Happy Bob app aims to “turn diabetes data into rewarding experiences”. It was showcased by it’s founder, Jutta Haaramo, at DiabetesMine’s D-Data event in June 2020.

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Happy Bob has been designed with the aim of being encouraging. It’s not getting users to add a sad face sticker for out of range glucose. But it does seem to have embraced an extrinsic reward paradigm which makes me a little wary.

I appreciate a lot about the company, including the fact that they are keen to get input into their design and they are open about the fact that it’s a product in development. They are exploring machine learning and looking for collaborations.

I also realise it’s easy to write about this stuff and another matter entirely to translate it into technology. And as Scott Hanselman just pointed out on Twitter:

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I’m planning to try Happy Bob out soon, but, as someone who switches off all alerts apart from urgent lows, I’ll need to be convinced. Will Bob’s company keep me calm, engaged? Will I enjoy it? Maybe I will, but it wouldn’t surprise me if I start experimenting with Snarky Bob straight away.

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And I’m not quite sure about Snarky Bob either.

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From what I’ve seen in the #WeAreNotWaiting community… once people have their data in an easy to understand, interactive, real-time format, and once they see their efforts being rewarded by results … when they have sufficient support, they are instrinsically motivated.

There are many diabetes design factors that can make diabetes a more joyful experience. It might be about colour, wearability, simplicity or ease of use, with optimally efficient outcomes. But it’s always function over form. And when it comes to joy, for me, it’s ideally what I think of as minimally intrusive delight.

The real unicorns are to be found in the life around us. We need devices that help us forget about the diabetes and engage in the life we were meant to live.