![]() One key to monitoring glycemic levels is the hemoglobin (A1c) measurement, which serves as a reflection of one’s estimated average glucose for the past three months (NIDDK, 2018). Difficulties in self-management in adolescents with T1D can lead to out-of-target blood glucose and potentially result in acute and chronic complications, such as increased risk of hospitalizations from severe hypoglycemia or diabetic ketoacidosis, and reduced overall health-related quality of life (Burdick et al., 2004 Miller et al., 2013 Realsen et al., 2012). Optimal engagement in these T1D-specific behaviors is a particular challenge for adolescents (Datye et al., 2015 Miller et al., 2015). The goal of T1D treatment is to achieve near-normal blood glucose levels via a complex constellation of medical and behavioral provisions, including glucose monitoring, carbohydrate counting, and insulin administration in response to a variety of factors including food intake, exercise, stress, and illness. T1D is a chronic condition in which the body is unable to produce insulin, a critical hormone in the pancreas that regulates blood glucose. Usage is monitored and presented in such a way that adolescents can keep track of their progress and readily identify what was learned at each attraction. Friendly characters (i.e., pedagogical agents) guide adolescents through the amusement park, providing coaching, feedback and encouragement. Adolescents earn awards such as digital badges and achievements by completing activities at the attractions/modules. Learning content focusing specifically on these two areas is presented as a series of amusement park attractions that adolescents visit (e.g., Burnout Bumper Cars, Planning Parachutes). Individualized learning modules are provided to adolescents and tailored to their individual needs in the areas of stress/burnout and time pressure/planning. Diabetes Journey uses an amusement park theme to provide a light and playful atmosphere. Gamification elements and a highly interactive mobile interface are used to provide adolescents with an appealing and engaging multimedia learning experience. ![]() The purpose of this article is to detail the design, development, and learner-centered evaluation of Diabetes Journey, a novel mobile health (mHealth) and telemedicine intervention for adolescents with type 1 diabetes (T1D) designed to promote problem-solving around identified T1D adherence barriers. Consideration of the pedagogical and sociocultural dimensions of learning is imperative when developing psychoeducational interventions. An extension to the framework is proposed to extend the social dimension to include socio-cultural and contextual considerations when designing mHealth applications. Implications for future designers and researchers are discussed regarding the social dimension of the sociotechnical-pedagogical usability framework. Findings from the user testing phase indicate Diabetes Journey is a user-friendly mHealth program with high usability that holds promise for enhancing adolescents' T1D self-management. Iterative design and formative evaluation were conducted across three design phases, and improvements were implemented following each phase. This approach applied design thinking methods within a Successive Approximation Model design process. Grounded in situativity theory and guided by a sociotechnical-pedagogical usability framework, Diabetes Journey was designed, developed, and evaluated using a learning experience design approach. ![]() Diabetes Journey is a gamified mHealth program designed to improve T1D self-management through a specific focus on decreasing adherence barriers and improving executive functioning skills for adolescents. The T1D treatment regimen is complex, and is a particular challenge for adolescents, who frequently experience a number of treatment adherence barriers (e.g., forgetfulness, planning and organizational challenges, stress). Type 1 diabetes (T1D) is a lifelong and chronic condition that can cause severely compromised health.
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