Questionnaire Method

4.10.3.1 Positives

Anonymity. The participants were provided with an additional opportunity at the end of the workshop to present their personal input without the influence of their peers.

Reflection. The participants completed the questionnaire after taking part in the interactive tasks. They were therefore able to reflect on the information presented to them as well as the discussions with other participants.

Lack of Embarrassment. Completing a questionnaire may have resulted in more complete and candid responses from participants who find this type of response more comfortable than participating in a group discussion. The anonymity afforded through this final method provided the opportunity for participants to reflect on the content from previous tasks so that they may respond to the questionnaire with a more informed view of what it means to express their adolescent user needs of medical devices.

4.10.3.2 Limitations

Time. The questionnaire was the last item in the workshops and if other activities overran it meant that time allocated for completion of the survey was

141 reduced and sometimes rushed. As a result participants may not have had the time to reflect fully on the questions and consider their responses.

Concentration. Although concentration levels during the workshops were maintained relatively well due to the interactive nature of the tasks, at the end of the session it was evident that the students’ attention dropped during the questionnaire. Some individuals did not appear to consider their answers and rushed through this activity.

Missing/ superfluous answers. Some surveys included erroneous answers and missing data. This indicates that the construction and design of the questionnaire might need re-addressing and that more intensive piloting would be useful to identify parts of the questionnaire which are not clear.

Individualism. In some instances it was quite difficult to get the students to fill out the questionnaire without conversing with their classmates. After having carried out the workshop in a relatively informal manner, encouraging them to discuss the tasks and examine the medical devices together, there were some participants who struggled to revert back to individual working and this may have affected the survey responses given by those participants

4.11 Discussion

The findings of the workshop activities support the literature and the clinician interviews that adolescent user needs may not be currently satisfied by the design of current medical devices.

The results of this study will inform the development of adolescent user requirements for medical devices. It is evident that an adolescent user group are interested in the ‘look and style’ of a device but also appreciate good usability and practicality. The aesthetics of a device can either help it to blend into an individual’s lifestyle or cause it to highlight their condition. For adolescents this may have a direct impact on their ability to ‘fit in’ with others.

This supports the ideas expressed by the clinicians in Chapter 3 that adolescents are concerned with the aesthetics of a device and that it may be an important factor for adolescent compliance of device use.

142 This study suggests that manufacturers should consider social acceptability and identity of adolescent users when developing devices. Both appear to be important to young people and have the potential to affect compliance. The participants, although naïve of the everyday commitment to managing a chronic condition, made reference to how a better general understanding of a chronic condition and the inherent medical devices could lead to better acceptance, particularly in social situations.

The workshop results suggest that adolescents place importance on interaction and feedback from a device and want to be informed whilst using these technologies. The participants’ overwhelming viewpoint was that many of the devices did not provide sufficient feedback to the user and subsequently were not engaging and informative enough.

It was encouraging to note the ability of the adolescent students to empathise with scenarios presented depicting the experiences of real adolescent users’

of medical devices, that despite their naivety they have the capacity to

‘decentre’ (Scaife & Rogers 1998) and offer insight on adolescent user preferences and needs. This supports the belief that young people are capable of considering the viewpoints of others and engaging in research that deals with sensitive issues in a serious and competent manner.

Gaining access to and involving young people in research involves additional ethical and methodological challenges in comparison with research involving adults. This study addresses how adolescents can be involved in research studies and found that with careful planning and inclusive design of the research strategy and methods the challenges associated with adolescent involvement in research can be overcome.

This study provides evidence to suggest that adolescents can form opinions about products and that they are willing and able to express their viewpoints in a mature and capable manner. As such the methods presented provide a useful framework demonstrating a technique for how adolescent user requirements can be elicited.

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4.11.1 Validity

Using Lincoln and Guba’s (1985) criteria to discuss the validity and reliability of the collected information, it is evident that the combination of human factors techniques utilised in the workshops provides a robust base from which to generate data with adolescent participants.

Conventional inquiry Naturalistic inquiry Methods to ensure quality

Internal validity Credibility Member checks, prolonged engagement in the field, data triangulation

External validity Transferability Thick description of setting and/or participants

Reliability Dependability Audit – researcher’s documentation of data, methods and decisions, researcher triangulation

Objectivity Confirm ability Audit and reflexivity

Table 4.6 Rigor in Qualitative Research (Contributions Lincoln & Guba 1985 and Ballinger 2006)

Consideration should be allocated to the issue of researcher reflexivity (Cromby & Nightingale 1999) and that the themes which emerged were identified and assigned by a single researcher. However the data from each activity within the workshop demonstrated overlapping and common themes, providing evidence that combining these methods can support the credibility (confidence of the ‘truth’ of the findings) and confirm ability (degree of neutrality or the extent to which the findings of a study are shaped by the respondents and not researcher bias) of the data. With regard to the issues of dependability (showing that the findings are consistent and could be repeated) and transferability (showing that the findings have applicability in other contexts) of the information there is endorsement of these criteria by the fact that the data sets were obtained at different times and places and that intersecting themes are present in the data analysis.

In addition to the analysis of data from the workshop activities and repetitions when combined with the overview from the literature it provides an argument to point to the fact that current medical device design does not cater for adolescent user requirements.

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4.11.2 Limitations

One limitation of the study is that it demonstrates use of a different proxy group, ‘healthy adolescents’ to assess medical devices, rather than real users.

These individuals will be inexperienced in the real life priorities and pressures of living with a chronic condition and having to utilise medical devices on a daily basis. The data from the workshops provides an insight into adolescent satisfaction with current medical device design. However analysis of the information will have to consider the deficiencies of this participant group and that they are not able to provide a full review due to their lack of personal experience with the devices and of chronic disease.

In terms of the limitations associated with the workshops it was acknowledged by the author and teaching staff that had more time been available for the running of the workshops, the persona sheets may have been more fully utilized. Additionally the adolescents’ appreciation of the ergonomics information provided may have been too much to consider in such a short space of time.

The issue of repetition of responses during Task 1 (the poster activity) is one which would be difficult to avoid due to the fact that students were enthused during the start of the workshop and this prompted discussion. It may also be an effect of participants wanting the reassurance of peer conversation to justify their comments about technologies they were unfamiliar with.

The adolescents did not display any reluctance or embarrassment with regard to discussing the topics of chronic conditions and devices. However one limitation to the study was the self consciousness shown by some individuals related to their handwriting (as reported by teaching staff). This was apparent during both the individual Task 1 and in Task 2 where participants had to contribute and write/ draw in front of the team. This was tackled to some extent by offering participants the choice to produce visual or diagrammatic representations of their thoughts and ideas however did not alleviate the problem.

Another limitation of this study is due to the school and classroom environments in which the workshops took place. With the team task being carried out in one classroom and all discussion carried out concurrently there

145 was little opportunity to record the content of individual team conversations. In future workshops this could be tackled by having groups separated.

Another issue associated with the school environment is that within this location and due to the presence of teaching staff, adolescent participants may not feel able to discuss their views freely and without censorship. For example, clinical staff suggest that relevant topics associated with medical device use can include relationships, risk taking behaviours or ‘taboo’ subjects.

However participants may not want to disclose details of these, particularly within the school environment.

Although the persona resources were not fully utilized it was interesting to note that participants would relate to the use of the device by either hypothesizing their own use of a medical device or that of a friend who had to make use of one. It was evident that the naive adolescent group, despite no firsthand experience of medical devices, had no hesitancy in trying to identify with adolescents who do have to use them. However the limitation of this is that unfamiliarity with the devices may impede the participants’ ability to assess the device and use of it. For example aesthetic qualities are likely to be more obvious to a naive participant whereas the contextual use issues might not be so apparent.

With regards to this study, epistemological reflexivity (Willig 2001) has impacted the results through the information sheets provided by the researcher to the student participants. By presenting ergonomics principles the aim was to ensure that all participants were provided with a basic knowledge of the discipline within which they were operating. However the downfall of this resource is that there will be implications within the data which are a result of the concepts presented within the workshop information. Even the decision making process surrounding device selection (presented in Chapter 3) and the eventual inclusion and exclusion of certain devices impact the data which has been obtained from this study.

Personal reflexivity (Willig 2001) will also have an impression on the outcomes of the study. During analysis the coding was driven by the data and pre-conceived notions about the information were suppressed. However

146 consideration should be applied to the conclusions as they are aligned with one person’s subjective perspective and interpretation (Bassey 1999).