Evaluating Psychosocial Support Provided by an Augmented Reality Device for Children With Type 1 Diabetes

Abstract

Type 1 diabetes (T1D), previously known as juvenile diabetes, has a large impact on everyday life and can pose a number of challenges for both children and their parents. A patient-centered design company, Sproutel, has designed and developed Jerry the Bear®—an interactive augmented reality (AR) stuffed animal toy bear designed to provide children with T1D with comfort and education about their diabetes management through play. We evaluated the AR device in a research study that involved participation over the course of approximately two weeks; the overall research project spanned three years and involved a variety of partners. We investigated whether Jerry the Bear offered psychosocial support to children with T1D and their parents and whether a new prototype version (equipped with audio feedback) offered any additional benefits. We conducted two versions of the study—a lab study ( n = 11) and a remote study without any in-person component ( n = 14). We found two major takeaways: (1) The results from the remote study closely paralleled the more time- and effort-intensive lab study, pointing to a promising avenue of research for hard-to-reach populations. (2) Jerry the Bear had a positive impact on children with T1D and their parents in almost all cases—in some the impact was more neutral, but never markedly negative. We did not find evidence for a consistent preference between the current Jerry the Bear and the new prototype. We also discuss the challenges of conducting rigorous research in highly specific target populations.

MyDiabetic, a serious game to support children’s education in diabetes mellitus I: Iterative Participatory Co-Design and Feasibility Study (Preprint)

“…After examining the survey presented in Table S14 in Multimedia Appendix 2 [ 13 , 16 , 18 , 19 , 21 , 24 - 31 , 33 , 42 , 43 , 50 - 65 ], it was observed that all games, except Packy & Marlon [ 16 ], lacked clinical validation. Furthermore, assessing adherence was not a focus in any of the games.…”

“…In addition, of the 18 games, 3 (17%) were previously available on Nintendo or mobile game stores, but currently only 2 (11%; MyDiabetic and Jerry the Bear) are available for download on mobile game stores. Most games were developed as prototypes or concept studies as part of academic projects, with only a few aimed at preschool children [ 50 - 52 ]. Only 1 (6%) of the 18 games addresses both basic (carbohydrate counting, blood glucose–level measurement, and insulin administration) and advanced (CGM and insulin pump) educational self-management skills [ 50 ].…”

“…Most games were developed as prototypes or concept studies as part of academic projects, with only a few aimed at preschool children [ 50 - 52 ]. Only 1 (6%) of the 18 games addresses both basic (carbohydrate counting, blood glucose–level measurement, and insulin administration) and advanced (CGM and insulin pump) educational self-management skills [ 50 ]. Nevertheless, no game tackles the complexity of diabetes management from such a wide perspective as MyDiabetic, in which unique features such as glucagon administration and ketoacidosis modules are included.…”

“…By carefully navigating the valley and finding the right balance between realism and abstraction, game designers can create experiences that are both educational and emotionally compelling [ 67 ]. MyDiabetic aimed to strike this balance by using cartoonish avatar designs and environments, while carefully incorporating technology features that closely resemble real-world settings, setting it apart from most other games [ 16 , 50 ].…”

Remote evaluation of augmented reality interaction with personal health information

“…As AR applications grow in popularity and their use expands to areas such as personal health information, there is a pressing need to evaluate AR systems "in the wild" (Rogers and Marshall, 2017) often remotely (Otiono et al, 2021). Conducting remote AR studies has the potential to reduce bias, increase generalizability, lower barriers to participant recruitment, and facilitate robust studies and analysis methods that require large sample sizes (Pratap et al, 2020;Ullman et al, 2021). While prior research has found remote study findings to be similar to the in-lab studies (Tullis et al, 2002;Nussenbaum et al, 2020), other challenges regarding remote studies persist.…”