Eye Tracking-based Evaluation of User Engagement with Standard and Personalised Digital Education for Diabetic Patients

Health education is a fundamental process in strategies to inform and involve patients with effective health management. Nevertheless, challenges exist in motivating patients to engage with health information. This paper describes a study which evaluated user engagement with generic and tailored digital formats of interactive health education for diabetic patients. We recruited 18 participants, nine of whom viewed a diabetic education booklet, and the remaining subjects viewed electronic personalised education. Eye tracking was used to measure visual engagement with the artefacts, and the users provided feedback regarding the aesthetics and usability of the education. The findings indicated that for both artefacts the participants attended predominantly to the text content. Moreover, for the personalised education, it was found that images that had been personalised in accordance with user characteristics received a greater amount of attention than non-tailored images.

Content

Author and article information

Contributors

Susan Quinn

Raymond Bond

Chris Nugent

Conference

Publication date: July 2018

Publication date (Print): July 2018

Pages: 1-12

Affiliations

[1 ] Ulster University

Jordanstown, BT37 0QB

Article

DOI: 10.14236/ewic/HCI2018.22

SO-VID: a63d9c23-2608-4f24-850f-faba1c46e115

License:

This work is licensed under a Creative Commons Attribution 4.0 Unported License. To view a copy of this license, visit http://creativecommons.org/licenses/by/4.0/

Conference name: Proceedings of the 32nd International BCS Human Computer Interaction Conference

Conference acronym: HCI

Conference number: 32

Conference location: Belfast, UK

Conference date: 4 - 6 July 2018

Conference sponsor: Electronic Workshops in Computing (eWiC)

Conference theme: Human Computer Interaction Conference

History

Product

1477-9358 BCS Learning & Development

Self URI (article page): https://www.scienceopen.com/hosted-document?doi=10.14236/ewic/HCI2018.22

Self URI (journal page): https://ewic.bcs.org/

Categories

Series title: Electronic Workshops in Computing

ScienceOpen disciplines: Applied computer science,Computer science,Security & Cryptology,Graphics & Multimedia design,General computer science,Human-computer-interaction

Keywords: Personalisation,Patient Education,Engagement,Eye Tracking

A. ColledgeJ. CarA. DonnellyA. Majeed 2008 Health information for patients: time to look beyond patient information leaflets. J. R. Soc. Med. 101 9 447 453
S. SpeirsS. ReesM. Tagoe 2008 An audit of foot surgery information leaflets from the patients’ perspective. The Foot 18 1 7 14
K. SørensenS. Van den BrouckeJ. FullamG. DoyleJ. PelikanZ. SlonskaH. Brand 2012 Health literacy and public health: A systematic review and integration of definitions and models. BMC Public Health 12 1 13
D. Nutbeam 2008 The evolving concept of health literacy. Soc. Sci. Med. 67 12 2072 2078
A. ShawS. IbrahimF. ReidM. UssherG. Rowlands 2009 Patients’ perspectives of the doctor–patient relationship and information giving across a range of literacy levels. Patient Educ. Couns. 75 4 114 120
M. Pohjanoksa-MäntyläJ. S. BellS. HelakorpiU. NärhiA. PelkonenM.S. Airaksinen 2011 Is the Internet replacing health professionals? A population survey on sources of medicines information among people with mental disorders. Soc. Psychiatry Psychiatr. Epidemiol. 46 5 373 379
B. K. KondilisP. D. AkrivosT. SardiE. SoteriadesM. Falagas 2010 Readability levels of health pamphlets distributed in hospitals and health centres in Athens, Greece. Public Health 124 10 547 552
C. HawJ. Stubbs 2011 Patient information leaflets for antidepressants: Are patients getting the information they need? J. Affect. Disord. 128 1-2 165 170
P. F. SviderN. AgarwalO. J. ChoudhryA. F. HajartS. BaredesJ. K. LiuJ. A. Eloy 2013 Readability assessment of online patient education materials from academic otolaryngology–head and neck surgery departments. Am. J. Otolaryngol. 34 1 31 35
C. S. MeppelinkN. Bol 2015 Exploring the role of health literacy on attention to and recall of text-illustrated health information: An eye-tracking study. Comput. Hum. Behav. 48 7 87 93
R. P. HawkinsM. KreuterK. ResnicowM. FishbeinA. Dijkstra 2008 Understanding tailoring in communicating about health. Health Educ. Res. 23 3 454 466
S. M. NoarC. N. BenacM. S. Harris 2007 Does tailoring matter? Meta-analytic review of tailored print health behavior change interventions. Psychol. Bull. 133 4 673
P. KrebsJ. O. ProchaskaJ. S. Rossi 2010 A meta-analysis of computer-tailored interventions for health behavior change. Prev. Med. 51 3-4 214 221
A. Dijkstra 2008 The psychology of tailoring‐ingredients in computer‐tailored persuasion. Social and Personality Psychology Compass 2 2 765 784
International Diabetes Federation 2015 IDF Diabetes Atlas - Seventh Edition http://www.diabetesatlas.org/ (retrieved date: March 27, 2018)
Diabetes UK 2017 Know Diabetes. Fight Diabetes. https://www.diabetes.org.uk/ (retrieved date: March 27, 2018
A. CoppolaL. SassoA. BagnascoA. GiustinaC. Gazzaruso 2016 The role of patient education in the prevention and management of type 2 diabetes: an overview. Endocrine 53 1 18 27
H. L. O’BrienE. G. Toms 2008 What is user engagement? A conceptual framework for defining user engagement with technology. J. Am. Soc. Inf. Sci. Technol. 59 6 938 955
H. L. O’BrienE. G. Toms 2013 Examining the generalizability of the User Engagement Scale (UES) in exploratory search. Information Processing & Management 49 5 1092 1107
H. O’BrienP. Cairns 2015 An empirical evaluation of the User Engagement Scale (UES) in online news environments. Information Processing & Management 51 4 413 427
M. B. CanoP. PerryR. AshmanK. Waite 2017 The influence of image interactivity upon user engagement when using mobile touch screens. Comput. Hum. Behav. 77406 412
Tobii Technology AB 2010 Tobii Eye Tracking. An introduction to eye tracking and Tobii Eye Trackers http://acuity-ets.com/downloads/Tobii%20Eye%20Tracking%20Introduction%20Whitepaper.pdf (retrieved date: June 16, 2017)
I. KersbergenM. Field 2017 Alcohol consumers’ attention to warning labels and brand information on alcohol packaging: Findings from cross-sectional and experimental studies. BMC Public Health 17 123
M. MackertS. E. ChamplinK. E. PaschB. D. Weiss 2013 Understanding Health Literacy Measurement Through Eye Tracking. J. Health Commun. 18 Suppl. 1 185 196
A. PooleL. J. Ball 2006 Eye tracking in human-computer interaction and usability research: current status and future prospects C. Ghaoui (ed) Encyclopedia of Human-Computer Interaction. IGI Global
S. B. BassT. F. GordonR. GordonC. Parvanta 2016 Using eye tracking and gaze pattern analysis to test a“dirty bomb” decision aid in a pilot RCT in urban adults with limited literacy. BMC Med. Inform. Decis. Mak 16 67
Quality Assurance Agency for Higher Education, Office of Qualifications and Examinations Regulation, Scottish Credit and Qualifications Framework Partnership, Council for the Curriculum Examinations and Assessment Accreditation, Credit and Qualifications Framework for Wales, Quality and Qualifications Ireland 2017 Qualifications can Cross Boundaries - A Guide to Comparing Qualifications in the UK and Ireland. Sixth Edition http://www.qaa.ac.uk/publications/information-and-guidance/publication?PubID=165#.WHbs_H3eJSV (retrieved date: March 27, 2018)
Diabetes UK 2011 Understanding diabetes. Your essential guide http://www.diabetes.org.uk/upload/How%20we%20help/catalogue/Understanding%20diabetes%20LG%20PRINT.pdf (June 16, 2017)
National Institute of Adult Continuing Education 2009 Readability. How to produce clear written materials for a range of readers http:// http://shop.niace.org.uk/readability.html (retrieved date: March 27, 2018)
S. QuinnR. BondC. Nugent 2017 Ontological modelling and rule-based reasoning for the provision of personalized patient education. Expert Syst. 34 2 e12134
Tobii Technology AB 2010 Tobii T/X series Eye Trackers http://www.tobiipro.com/siteassets/tobii-pro/product-descriptions/tobii-pro-tx-product-description.pdf (retrieved date: March 27, 2018)
A. Olsen 2012 The Tobii I-VT Fixation Filter Algorithm description http://www.tobiipro.com/siteassets/tobii-pro/learn-and-support/analyze/how-do-we-classify-eye-movements/tobii-pro-i-vt-fixation-filter.pdf (retrieved date: March 27, 2018)
F. C. BullC. HoltM. KreuterE. ClarkD. Scharff 2001 Understanding the effects of printed health education materials: which features lead to which outcomes? J. Health Commun. 6 3 265 280
M. L. A. LustriaJ. CorteseS. M. NoarR.L. Glueckauf 2009 Computer-tailored health interventions delivered over the Web: review and analysis of key components. Patient Educ. Couns. 74 2 156 173
N. Bol, van J. C. WeertE. F. LoosJ. C. Romano BergstromS. BolleE. M. Smets 2016 How are online health messages processed? Using eye tracking to predict recall of information in younger and older adults. J. Health Commun. 21 4 387 396
N. Bol, van J. C. Weert, de H. C. HaesE. F. Loos, de S. HeerD. SikkelE. M. Smets 2014 Using cognitive and affective illustrations to enhance older adults’ website satisfaction and recall of online cancer-related information. Health Commun. 29 7 678 688
S. BakhshiD. A. ShammaE. Gilbert 2014 Faces engage us: Photos with faces attract more likes and comments on Instagram. Proceedings of the 32nd Annual ACM Conference on Human Factors in Computing Systems 2014 965 974
S. Fletcher-WatsonJ. M. FindlayS.R. LeekamV. Benson 2008 Rapid detection of person information in a naturalistic scene. Perception 37 4 571 583
E. BirminghamW. F. BischofA. Kingstone 2009 Saliency does not account for fixations to eyes within social scenes. Vision Research 49 24 2992 3000
M. CerfJ. HarelW. EinhäuserC. Koch 2008 Predicting human gaze using low-level saliency combined with face detection. J. C. PlattD. KollerY. SingerS. T. Roweis (eds) Advances in Neural Information Processing Systems 20: 21st Annual Conference on Neural Information Processing Systems 2007 Curran Associates Inc
C. TsaiS. Guan 2015 Identifying regions of interest in reading an image. Displays 39 33 41
E. BirminghamW. F. BischofA. Kingstone 2007 Why do we look at people’s eyes? Journal of Eye Movement Research 1 1

Comments

Comment on this article

[1] A. ColledgeJ. CarA. DonnellyA. Majeed 2008 Health information for patients: time to look beyond patient information leaflets. J. R. Soc. Med. 101 9 447 453

[2] S. SpeirsS. ReesM. Tagoe 2008 An audit of foot surgery information leaflets from the patients’ perspective. The Foot 18 1 7 14

[3] K. SørensenS. Van den BrouckeJ. FullamG. DoyleJ. PelikanZ. SlonskaH. Brand 2012 Health literacy and public health: A systematic review and integration of definitions and models. BMC Public Health 12 1 13

[4] D. Nutbeam 2008 The evolving concept of health literacy. Soc. Sci. Med. 67 12 2072 2078

[5] A. ShawS. IbrahimF. ReidM. UssherG. Rowlands 2009 Patients’ perspectives of the doctor–patient relationship and information giving across a range of literacy levels. Patient Educ. Couns. 75 4 114 120

[6] M. Pohjanoksa-MäntyläJ. S. BellS. HelakorpiU. NärhiA. PelkonenM.S. Airaksinen 2011 Is the Internet replacing health professionals? A population survey on sources of medicines information among people with mental disorders. Soc. Psychiatry Psychiatr. Epidemiol. 46 5 373 379

[7] B. K. KondilisP. D. AkrivosT. SardiE. SoteriadesM. Falagas 2010 Readability levels of health pamphlets distributed in hospitals and health centres in Athens, Greece. Public Health 124 10 547 552

[8] C. HawJ. Stubbs 2011 Patient information leaflets for antidepressants: Are patients getting the information they need? J. Affect. Disord. 128 1-2 165 170

[9] P. F. SviderN. AgarwalO. J. ChoudhryA. F. HajartS. BaredesJ. K. LiuJ. A. Eloy 2013 Readability assessment of online patient education materials from academic otolaryngology–head and neck surgery departments. Am. J. Otolaryngol. 34 1 31 35

[10] C. S. MeppelinkN. Bol 2015 Exploring the role of health literacy on attention to and recall of text-illustrated health information: An eye-tracking study. Comput. Hum. Behav. 48 7 87 93

[11] R. P. HawkinsM. KreuterK. ResnicowM. FishbeinA. Dijkstra 2008 Understanding tailoring in communicating about health. Health Educ. Res. 23 3 454 466

[12] S. M. NoarC. N. BenacM. S. Harris 2007 Does tailoring matter? Meta-analytic review of tailored print health behavior change interventions. Psychol. Bull. 133 4 673

[13] P. KrebsJ. O. ProchaskaJ. S. Rossi 2010 A meta-analysis of computer-tailored interventions for health behavior change. Prev. Med. 51 3-4 214 221

[14] A. Dijkstra 2008 The psychology of tailoring‐ingredients in computer‐tailored persuasion. Social and Personality Psychology Compass 2 2 765 784

[15] International Diabetes Federation 2015 IDF Diabetes Atlas - Seventh Edition http://www.diabetesatlas.org/ (retrieved date: March 27, 2018)

[16] Diabetes UK 2017 Know Diabetes. Fight Diabetes. https://www.diabetes.org.uk/ (retrieved date: March 27, 2018

[17] A. CoppolaL. SassoA. BagnascoA. GiustinaC. Gazzaruso 2016 The role of patient education in the prevention and management of type 2 diabetes: an overview. Endocrine 53 1 18 27

[18] H. L. O’BrienE. G. Toms 2008 What is user engagement? A conceptual framework for defining user engagement with technology. J. Am. Soc. Inf. Sci. Technol. 59 6 938 955

[19] H. L. O’BrienE. G. Toms 2013 Examining the generalizability of the User Engagement Scale (UES) in exploratory search. Information Processing & Management 49 5 1092 1107

[20] H. O’BrienP. Cairns 2015 An empirical evaluation of the User Engagement Scale (UES) in online news environments. Information Processing & Management 51 4 413 427

[21] M. B. CanoP. PerryR. AshmanK. Waite 2017 The influence of image interactivity upon user engagement when using mobile touch screens. Comput. Hum. Behav. 77406 412

[22] Tobii Technology AB 2010 Tobii Eye Tracking. An introduction to eye tracking and Tobii Eye Trackers http://acuity-ets.com/downloads/Tobii%20Eye%20Tracking%20Introduction%20Whitepaper.pdf (retrieved date: June 16, 2017)

[23] I. KersbergenM. Field 2017 Alcohol consumers’ attention to warning labels and brand information on alcohol packaging: Findings from cross-sectional and experimental studies. BMC Public Health 17 123

[24] M. MackertS. E. ChamplinK. E. PaschB. D. Weiss 2013 Understanding Health Literacy Measurement Through Eye Tracking. J. Health Commun. 18 Suppl. 1 185 196

[25] A. PooleL. J. Ball 2006 Eye tracking in human-computer interaction and usability research: current status and future prospects C. Ghaoui (ed) Encyclopedia of Human-Computer Interaction. IGI Global

[26] S. B. BassT. F. GordonR. GordonC. Parvanta 2016 Using eye tracking and gaze pattern analysis to test a“dirty bomb” decision aid in a pilot RCT in urban adults with limited literacy. BMC Med. Inform. Decis. Mak 16 67

[27] Quality Assurance Agency for Higher Education, Office of Qualifications and Examinations Regulation, Scottish Credit and Qualifications Framework Partnership, Council for the Curriculum Examinations and Assessment Accreditation, Credit and Qualifications Framework for Wales, Quality and Qualifications Ireland 2017 Qualifications can Cross Boundaries - A Guide to Comparing Qualifications in the UK and Ireland. Sixth Edition http://www.qaa.ac.uk/publications/information-and-guidance/publication?PubID=165#.WHbs_H3eJSV (retrieved date: March 27, 2018)

[28] Diabetes UK 2011 Understanding diabetes. Your essential guide http://www.diabetes.org.uk/upload/How%20we%20help/catalogue/Understanding%20diabetes%20LG%20PRINT.pdf (June 16, 2017)

[29] National Institute of Adult Continuing Education 2009 Readability. How to produce clear written materials for a range of readers http:// http://shop.niace.org.uk/readability.html (retrieved date: March 27, 2018)

[30] S. QuinnR. BondC. Nugent 2017 Ontological modelling and rule-based reasoning for the provision of personalized patient education. Expert Syst. 34 2 e12134

[31] Tobii Technology AB 2010 Tobii T/X series Eye Trackers http://www.tobiipro.com/siteassets/tobii-pro/product-descriptions/tobii-pro-tx-product-description.pdf (retrieved date: March 27, 2018)

[32] A. Olsen 2012 The Tobii I-VT Fixation Filter Algorithm description http://www.tobiipro.com/siteassets/tobii-pro/learn-and-support/analyze/how-do-we-classify-eye-movements/tobii-pro-i-vt-fixation-filter.pdf (retrieved date: March 27, 2018)

[33] F. C. BullC. HoltM. KreuterE. ClarkD. Scharff 2001 Understanding the effects of printed health education materials: which features lead to which outcomes? J. Health Commun. 6 3 265 280

[34] M. L. A. LustriaJ. CorteseS. M. NoarR.L. Glueckauf 2009 Computer-tailored health interventions delivered over the Web: review and analysis of key components. Patient Educ. Couns. 74 2 156 173

[35] N. Bol, van J. C. WeertE. F. LoosJ. C. Romano BergstromS. BolleE. M. Smets 2016 How are online health messages processed? Using eye tracking to predict recall of information in younger and older adults. J. Health Commun. 21 4 387 396

[36] N. Bol, van J. C. Weert, de H. C. HaesE. F. Loos, de S. HeerD. SikkelE. M. Smets 2014 Using cognitive and affective illustrations to enhance older adults’ website satisfaction and recall of online cancer-related information. Health Commun. 29 7 678 688

[37] S. BakhshiD. A. ShammaE. Gilbert 2014 Faces engage us: Photos with faces attract more likes and comments on Instagram. Proceedings of the 32nd Annual ACM Conference on Human Factors in Computing Systems 2014 965 974

[38] S. Fletcher-WatsonJ. M. FindlayS.R. LeekamV. Benson 2008 Rapid detection of person information in a naturalistic scene. Perception 37 4 571 583

[39] E. BirminghamW. F. BischofA. Kingstone 2009 Saliency does not account for fixations to eyes within social scenes. Vision Research 49 24 2992 3000

[40] M. CerfJ. HarelW. EinhäuserC. Koch 2008 Predicting human gaze using low-level saliency combined with face detection. J. C. PlattD. KollerY. SingerS. T. Roweis (eds) Advances in Neural Information Processing Systems 20: 21st Annual Conference on Neural Information Processing Systems 2007 Curran Associates Inc

[41] C. TsaiS. Guan 2015 Identifying regions of interest in reading an image. Displays 39 33 41

[42] E. BirminghamW. F. BischofA. Kingstone 2007 Why do we look at people’s eyes? Journal of Eye Movement Research 1 1