이해관계자 요구사항 및 벤치마킹 기반 삼킴건강관리 서비스 어플리케이션 개발

Abstract

Dysphagia is a symptom of difficulty in chewing and swallowing food. Dysphagia are associate with neurologic diseases such as stroke and Parkinson's disease, or with elderly people with aging of swallowing-related organs. Unmanaged dysphagia can cause complications such as aspiration pneumonia, dehydration and malnutrition, and in severe cases can lead to death. Symptoms of dysphagia cause serious physical and emotional problems in patients, which can reduce the overall quality of life. Although early detection and continuous management are necessary for the prevention and treatment of dysphagia, most swallowing health care services are provided to patients in the medical environment. In addition, there is a need for content for preventive management services for general elderly people with high risk of swallowing disorders. The present study aimed to develop a swallowing health care service application that comprehensively satisfies the requirements of the elderly, patients with dysphagia, caregivers, and medical professionals specialized in s dysphagia. The specific goals of the study are (1) understanding stakeholder requirements, (2) deriving service app development strategies, and (3) developing elderly-friendly App. First, in the stakeholder needs analysis stage, the needs and importance in the process of prevention/screening (P/S), evaluation/diagnosis (E/D), and treatment/training (T/T) were identified for stakeholders. Stakeholder were recruited into five groups: the normal elderly group, risk group, patient group, carer and medical professional with dysphagia. 48 stakeholder requirements were identified through interviews and surveys. The importance of each identified needs was identified for a total of 125 people from five stakeholder groups by survey based on a 7-point Likert scale. The importance of average requirements of all stakeholders was significantly higher in E/D (6.0 ~ 6.6 points) and T/T (6.1 ~ 6.4 points) than in P/S (5.0 ~ 5.7 points). Second, the service development strategy was derived through benchmarking of the existing swallowing health care service app. For analysis of the currently commercialized app, 15 apps were identified, and functional analysis and requirement satisfaction evaluation were performed. Through requirement satisfaction evaluation analysis, main competitive service was ‘Swallow Rehapp’, which provided a comprehensive evaluation and training program, while the usability of the interface was low. As a result of the analysis, the service development strategy was derived to support diagnosis through comprehensive evaluation and analysis of swallowing function, improvement of swallowing training learning and ease of self-check, improvement of ease of use for the elderly, psychosocial evaluation and provision of training. Third, for develop an elderly-friendly app, usability of the application was improved through usability evaluation and improvement. 30 participants (12 males and 18 females) over 65 years of age participated in subjective satisfaction evaluation based on a 7-point Likert scale and behavioral observation to measure execution time and number of errors of the prototype app. The evaluation target was composed of 13 GUI types (5 screens, 8 icons) and 7 tasks related to major functions. In the stage of analyzing the usability evaluation results, an additional heuristic evaluation by ergonomic experts was performed. 13 types of usability problems (lower familiarity with icons, difficulty in identifying menu movement paths, errors in function recognition, small button size, difficulty in recognizing the operation sequence, etc.) were derived, and 11 types of improvements (using familiar images of icons, minimization of the menu movement path, induction of actions according to the order of operation, visualization of button feedback, etc.) were developed. The effectiveness of improving usability of app was validate through comparative evaluation before and after improvement. After improvement compared to before improvement, subjective satisfaction increased by 16%-80% in most evaluation items, and execution time (56%) and number of errors (65%) decreased in ‘check training record’ task (n=15). The swallowing health care service app developed in the present study can contribute to helping the elderly and patients to self manage swallowing problems in daily life. Findings through stakeholder needs survey can help to identify comprehensive swallowing health care needs for a variety of stakeholders. And the swallowing healthcare service app development strategies derived through service analysis can be used to plan a new service that can preempt competitive advantage in the swallowing app market. Lastly, the usability improvements of the app can help in the development of health care apps for the elderly.