JMIR Publications

ABSTRACT

Background:

Older adults with type 2 diabetes (T2D) in long-term care often struggle with dietary self-management due to standardized routines, cognitive and sensory variability, and reliance on caregivers.

Objective:

This study aimed to co-design and evaluate a digital dietary management system that supports equitable dietary self-management for older adults with T2D in long-term care while aligning with caregiver workflows and clinical safety needs.

Methods:

We conducted a participatory co-creation process including interviews, one-day shadowing, and a 90-minute co-creation workshop with residents (n=12), family caregivers (n=4), and nurses (n=4) in a long-term care facility. Workshop outputs guided iterative low- to high-fidelity prototyping in Sketch and Figma. This process culminated in a high-fidelity interactive prototype (digital dietary management system) featuring a consolidated reminder dashboard, an adaptive portion-control slider, and integrated glucose–meal feedback visualization, designed with age-friendly and universal design principles (eg, large fonts, high-contrast labels, simplified icons, and multimodal feedback). Usability testing was conducted with 12 participants (6 residents, 3 caregivers, 3 nurses) using task-based scenarios (log glucose, adjust meal portion, schedule medication reminder), with video-recorded observations and counterbalanced task order. Outcomes included task success rate, completion time, error count, System Usability Scale (SUS), and satisfaction ratings.

Results:

Usability testing showed a mean task success rate of 96.31%, mean completion time of 1.9 minutes (SD 0.4), and 0.3 errors per session. Perceived usability was high (mean SUS 81.0, SD 5.2), with high satisfaction (mean 4.5/5, SD 0.5). Qualitative feedback indicated reduced cognitive effort through simplified reminders and single-motion portion adjustment, improved perceived autonomy for residents, and reduced double-recording for caregivers and nurses, supporting more equitable self-management in institutional routines.

Conclusions:

Participatory co-creation produced a highly usable dietary management system tailored to long-term care workflows. Equity-oriented interaction design (accommodating sensory/cognitive variability) combined with safety-aware reminders and feedback integration may support older adults' autonomy while streamlining caregiver monitoring. The design approach and core interaction patterns may be transferable to other chronic disease self-management tools in institutional care, supporting broader adoption and scalability. Clinical Trial: All participants provided written informed consent after receiving detailed information about the study purpose, procedures, potential risks, and their right to withdraw at any time without penalty. The study protocol was approved by the Institutional Review Board of Hunan University (Ref. No. P92531) and adhered to the Declaration of Helsinki and EFPA ethical guidelines. All interview and observation data were anonymized prior to analysis through de-identification of transcripts, and any potentially identifying information was removed from field notes and study materials. Confidentiality was maintained throughout the study, and study data were stored securely and were accessible only to the research team. Participants did not receive financial or material compensation for their involvement. Given that participants were older adults residing in a long-term care facility, additional safeguards were implemented to support informed and voluntary participation, including plain-language consent procedures, comprehension checks (teach-back), and the option to pause or discontinue sessions at any time.