Identification of Case Study

From these results and with the advice from clinical staff at the Queens Medical Centre Nottingham, it was possible to identify a case study device for development. Based on the data from the workshops the medical devices which appeared to appeal least to the adolescent participants were the collection of respiratory devices, generating more negative statements than the endocrinology ones despite the fact that there were fewer devices. This data suggests that the respiratory devices may not be meeting some adolescent user requirements. This is supported by the greater number of coded Suggested Improvements for this set of devices. There were five device candidates within the respiratory category (Figure 4.4), each of which was the potential focus of a detailed case study.

122 The asthma inhaler and the I-neb® are drug delivery devices. The latter has its main purpose in the care regime of people with Cystic Fibrosis. The other three devices, the acapella®, PEP Mask and Spirometer are all respiratory physiotherapy devices with treatment applications for a variety of respiratory conditions, including Cystic Fibrosis, Chronic Obstructive Pulmonary Disease (COPD), asthma and persistent cough.

From the workshop data it was apparent that there were few negative design aspects identified from the assessment of the Asthma Inhaler. Whether this was due to the student’s familiarity of the device and a better understanding of the functional requirements to treat the condition or the fact it genuinely meets adolescent user needs is unclear. Further investigation would be required to clarify this point.

The I-neb® is a fairly new evolution of drug delivery and is being used in place of traditional nebulisers. Currently there are relatively few in circulation within the local healthcare system and being used by adolescents so the pool of potential participants for this device was smaller than other device user populations. Another more important reason for excluding the I-neb® in the continuation in this study is that in terms of adherence of use, there is a reduced problem of adolescents adhering to their drug treatment regimens than their recommended physiotherapy routine. The guidance provided by the paediatric respiratory team proposed that it would be more valuable to focus efforts on establishing adolescent user needs in specific relation to the physiotherapy devices.

Subsequently discussions turned to the final three devices, the acapella®, PEP Mask and Spirometer. The Improvement Suggestions made for the PEP Mask and Spirometer could be considered quite superficial in terms of concept and potential impact. Examples being to “shorten the tubes” and

“digitalise the gauge” on the PEP Mask and for the Spirometer to “add more colour” and “make it more stylish and smaller”. Clinical staff described how

“Teenagers like to be treated different from children... You mostly see it when they try to decorate their devices or what they use to carry it around it in so that it looks different from the same ones used by younger children”.

123 This point is relevant particularly to the Spirometer, the adolescent participants spoke about how they thought it was aimed at children but was not suitable for teenagers. They suggested that improvements on it should focus on the needs of children rather than adolescents.

In contrast the acapella® generated more in-depth conversation between the participants, stimulating more varied and detailed ideas from the teenagers.

Not only did they discuss the Aesthetic options and the potential for Customisation, they acknowledged that some aspects of the acapella® were preferred over other devices and commented on the materials of the device, stating that

“The green (plastic) seems quite robust” although “it would be better if there were softer mouldings for the hands...for when you have to use it for a long time”.

Clinical staff were also keen to highlight how the lack of knowledge and understanding surrounding the CF condition mean that Social Acceptance and Emotions such as embarrassment & self consciousness cause users to be secretive of their condition and their medical device.

“Quite often they won’t show people their stuff and don’t feel comfortable getting the equipment out when people don’t know about it and it all looks a bit strange”

“They try to take their medications and do their physio outside of school”.

In addition, specific comments about the acapella® and the design of the dial which determines the air flow resistance, showed that the participants were less than satisfied with this element of the design.

“It isn’t very obvious”

“It should be a different colour to the rest of it”

“It could easily get knocked off the right number”

Another aspect thought to be important by the students was that this particular device did not have an interface and therefore Interaction and Feedback

124 emerged as an important theme. This was of particular significance when devices have high frequency and duration of use e.g. several times a day for 20 minutes at a time. This concept was supported by the input from the clinical staff, who stated that,

“Boredom is the main problem with most of these devices”

“Nagging by the parent is a problem and the kids don’t like it....it would be good if there was more option for monitoring the exercises”.

The adolescent participants thought the user should be provided with more information than just the physical vibrations in the chest. This prompted questions about why there was no screen and comparison with other devices

“Why hasn’t it got a screen like the others?”

“It would be better if it had something telling you if you were doing it right”,

“What if you lose track of time when you’re using it...how would you know then?”

Follow up suggestions to this included: built in interfaces, the ability to attach the device to P.C monitors, mobile phones or provide feedback through gaming option and proposing a range of other audible, visual and tactile methods of feeding back to the user. The data highlighted the fact that a screen could provide a variety of functions for the user, some of which could be tailored to meet the needs of different user groups. Examples of which were: alarms for times and durations of physiotherapy routine and feedback regarding correct technique of use, this issue was subsequently raised as being of particular importance to the clinical staff.

Consultations were held with the paediatric cystic fibrosis team and a specialist physiotherapy nurse on the team to review the analysis of the data and to discuss the options for the case study device. Their opinion was that the acapella®, although one of the more modern options available for use could still benefit from user needs assessment and development. They reported that when used correctly and according to the specified treatment

125 routine it can be a very effective tool in the physiotherapy routine of young patients with CF. This presented two challenges, ensuring that the technique of use is proper and consistent (correct use) whilst encouraging the patients to adhere to treatment regimens to make certain that they achieve the best potential health outcome (regular use).

As a consequence of the workshop data analysis and the information provided by clinical staff, the acapella® physiotherapy device was chosen as the case study example to show how the inclusion of real adolescents user requirements can assist the development of the device.