Purpose: We developed a web-based Geriatric Diabetes Decision Aid (GDDA) which combines a decision analytic model of DM complications with a geriatric life expectancy prediction tool. To date, little is known about the best ways to display the risk and benefits of varying levels of glycemic control to older patients with DM and their providers. We present the patients and provider acceptability testing of the GDDA.
Methods: 9 patients and 12 providers from local federally qualified health centers were interviewed utilizing qualitative methods regarding computer usage patterns, patient risk comprehension, as well as their opinions on methods of visually displaying the lifetime risk of amputation at different glycemic targets (A1c of 7, 8, and 9%). Options included a bar graph, tables, and pictograms. Patients and providers were also asked questions about the website’s overall usability and design. Interviews were audio recorded and transcribed for accuracy and theme saturation. Patients and providers used the website throughout the interview.
Results: Mean patient age was 68 and 56% were female. Nine providers were male. All the providers were either in family or internal medicine. Four patients owned and used a computer regularly, three regularly used but did not own and two did not own or use computers. When tested on their knowledge of risk of amputation, only two patients failed to understand. Risk display results were different between patients and providers. Six patients preferred tables which showed the incidence of events per thousand patients. Seven providers thought patients would prefer pictograms for the different A1c targets. Patients and providers agreed that the use of color, pictures, large print, simple wording and easy to operate navigation and scroll buttons were a necessary part of the website design. All patients agreed that the GDDA is a tool that could assist in learning about A1c and discussing treatment goals with their doctor. All providers thought the GDDA could be a useful tool to stimulate conversation regarding A1c targets with their patients.
Conclusions: The GDDA is an instrument that may be able to assist patients and providers in determining individualized glycemic control targets. Pictures, simple wording, and easy navigation buttons can increase usability. Provider opinions should not be used as a proxy for patient opinions in determining the acceptability of website design.