Annalu Waller

A randomized controlled trial of Sweet Talk, a text-messaging system to support young people with diabetes.

Aims  To assess Sweet Talk, a text‐messaging support system designed to enhance self‐efficacy, facilitate uptake of intensive insulin therapy and improve glycaemic control in paediatric patients with Type 1 diabetes.

Patients’ Engagement With “Sweet Talk” – A Text Messaging Support System for Young People With Diabetes

Background Guidelines for optimizing type 1 diabetes in young people advocate intensive insulin therapy coupled with personal support from the health care team. “Sweet Talk” is a novel intervention designed to support patients between clinic visits using text messages sent to a mobile phone. Scheduled messages are tailored to patient profiles and diabetes self-management goals, and generic messages include topical “newsletters” and anonymized tips from other participants. The system also allows patients to submit data and questions to the diabetes care team. Objectives The aim was to explore how patients with type 1 diabetes interact with the Sweet Talk system in order to understand its utility to this user group. Methods Subjects were 64 young people with diabetes who were participating in the intervention arms of a randomized controlled trial. All text messages submitted to Sweet Talk during a 12-month period were recorded. Messaging patterns and content were analyzed using mixed quantitative and qualitative methods. Results Patients submitted 1180 messages during the observation period (mean 18.4, median 6). Messaging frequency ranged widely between participants (0-240) with a subset of 5 high users contributing 52% of the total. Patients’ clinical and sociodemographic characteristics were not associated with total messaging frequency, although girls sent significantly more messages unrelated to diabetes than did boys (P = .002). The content of patients’ messages fell into 8 main categories: blood glucose readings, diabetes questions, diabetes information, personal health administration, social messages, technical messages, message errors, and message responses. Unprompted submission of blood glucose values was the most frequent incoming message type (35% of total). Responses to requests for personal experiences and tips generated 40% of all the incoming messages, while topical news items also generated good responses. Patients also used the service to ask questions, submit information about their self-management, and order supplies. No patients nominated supporters to receive text messages about their self-management goals. Another option that was not used was the birthday reminder service. Conclusions Automated, scheduled text messaging successfully engaged young people with diabetes. While the system was primarily designed to provide “push” support to patients, submission of clinical data and queries illustrates that it was seen as a trusted medium for communicating with care providers. Responses to the newsletters and submission of personal experiences and tips for circulation to other participants also illustrate the potential value of such interventions for establishing a sense of community. Although participants submitted relatively few messages, positive responses to the system suggest that most derived passive support from reading the messages. The Sweet Talk system could be readily adapted to suit other chronic disease models and age groups, and the results of this study may help to inform the design of future text message support interventions.

Developing technology for autism: an interdisciplinary approach

We present an interdisciplinary methodology for designing interactive multi-modal technology for young children with autism spectrum disorders (ASDs). In line with many other researchers in the field, we believe that the key to developing technology in this context is to embrace perspectives from diverse disciplines to arrive at a methodology that delivers satisfactory outcomes for all stakeholders. The ECHOES project provided us with the opportunity to develop a technology-enhanced learning (TEL) environment that facilitates acquisition and exploration of social skills by typically developing (TD) children and children with autism spectrum disorders (ASDs). ECHOES’ methodology and the learning environment rely crucially on multi-disciplinary expertise including developmental psychology, visual arts, human–computer interaction, artificial intelligence, education, and several other cognate disciplines. In this article, we reflect on the methods needed to develop a TEL environment for young users with ASDs by identifying key features, benefits, and challenges of this approach.

Participatory design of a text message scheduling system to support young people with diabetes.

Effective self-management of diabetes requires considerable behavioural change and continuous support from health professionals, which can be expensive. Information technology has the potential to offer cost-effective patient support, but internet use mostly relies on the active seeking of information. Text messaging offers an ideal channel for delivering ‘push’ support and facilitating reciprocal communication between patient and health professional. This paper describes a participatory design methodology to develop a text message scheduling system for supporting young people with diabetes. The project illustrates how this familiar design approach can be used in a short-term project to deliver a successful medical application. Close working between clinician and software developer led to successive user-informed iterations as the clinician became more aware of the system’s potential and identified barriers. The result was a reliable, functional, acceptable and usable system that was effectively implemented in its intended setting.

THE CONSTRUCTION OF A PUN GENERATOR FOR LANGUAGE SKILLS DEVELOPMENT

Since the early 1990s, there have been a number of small-scale computer programs that automatically constructed simple verbal jokes (puns), but none of these were fully developed systems that could be used for a practical application. We describe the building and testing of the STANDUP program – a large-scale, robust, interactive, user-friendly pun-generator (inspired by Binsteds JAPE program), which is aimed at allowing children, particularly those with communication disabilities, to develop their linguistic skills. The STANDUP system was designed in consultation with potential users and suitable experts, was rigorously engineered using public-domain linguistic data, and has a special purpose, child-friendly, graphical user interface. The software was tested successfully with real users (children with complex communication needs).

Including accessibility within and beyond undergraduate computing courses

This paper presents a unique approach to undergraduate teaching in which accessibility topics are completely integrated throughout the curriculum, treating accessibility not as a separate topic, but rather as an integral part of design and development. Means of accomplishing this integration throughout the entire four-year curriculum are presented. We also describe how our expertise in accessible design has extended beyond the education of computer science and engineering students to include Web content authors across campus.

Evaluating the STANDUP Pun Generating Software with Children with Cerebral Palsy

The interactive STANDUP software was developed to provide children who use augmentative and alternative communication (AAC) with a “language playground.” The software provides appropriate functionality for users with physical, speech, and language impairments to generate and tell novel punning riddles at different levels of complexity. STANDUP was evaluated with nine children with cerebral palsy during an eight-week study. Results show that the participants were able to generate and tell novel jokes with minimal or no support. The use of STANDUP impacted favorably on general AAC use. The study results also suggested that STANDUP could potentially have a positive effect on social and pragmatic skills. Further research to investigate the impact of STANDUP on communication skills is proposed. Suggestions for future software development include providing users with opportunities to complete jokes and to integrate online dictionaries when new vocabulary is encountered.

Using Written Stories to Support the Use of Narrative in Conversational Interactions: Case Study

Speaking children learn to communicate effectively through interactions with their friends and adults by repeatedly relating past experiences. Missing out on the experience of relating personal narratives may have implications for the language and communication development of augmentative and alternative communication users. This article presents a detailed case study of Anne, a dyspraxic 10-year-old girl. Researchers introduced Anne to a narrative-based communication device and supported her use of it over a 1.5-year period. Changes in Annes communication skills were monitored and measured both quantitatively and qualitatively during this time. The results showed that Annes stories were constantly used and updated. The device appeared to have a therapeutic effect on Annes verbal skills, and improvements in her narrative and social skills and self-esteem were also observed.

Communication Access to Conversational Narrative

This article describes methods that have been developed to provide augmentative and alternative communication communicators with better access to narrative conversation. It begins by highlighting the need to provide access to conversational narrative for people with complex communication needs, arguing that this type of conversation plays an important role in interaction that is both effective and satisfying. It proceeds by describing how young children and people with complex communication disabilities access narratives through interactional support. The results of research projects that have used technology to support interactional conversation (telling jokes, sharing experiences, telling nonfictional stories) are presented as examples of how technology can support people who rely on augmentative and alternative communication to become more effective conversationalists and storytellers.

How do members of different language communities compose sentences with a picture-based communication system?—a cross–cultural study of picture–based sentences constructed by English and Japanese speakers

A number of picture-based communication systems are in use by nonspeaking people. They are not widely used in Japan. This may be because the systems, although pictorial in nature, tend to be based on English sentence formation. This study was conducted to provide a basis for a discussion about the use by people in non-English-speaking cultures of graphic-based communication aids developed in English-speaking countries. Subjects (80 Japanese and 43 English speakers) were asked to compose picture-based sentences using a computer-based system. The order of graphic symbols on the screen and the effects of syntax markers were investigated as independent variables. The results show that syntax markers and the symbol order had an important effect on the sentences produced by Japanese-speaking subjects. In addition, both the Japanese and the English speakers omitted words when using the picturebased communication system as compared to using speech.