Designing and Evaluating of a Guideline-Based Recommender-Interpreter System to Inform Diabetic Patients about the Status of Periodic Lab Tests

Introduction: One of the most important issues in managing diabetes is the periodic checkups and tests to prevent the secondary complications of the disease. Low level of literacy in patients with diabetes, and the widespread use of abbreviations and numbers in the lab test results, makes it difficult for the patient to understand and interpret her health status. The purpose of this study is to design an expert system based on clinical guidelines in order to interpret the laboratory test results to patients and provide relevant recommendations in a textual report. Material and Methods: The study consists of two phases: the design and the evaluation. Design phase consists of 4 stages. In the first step, based on a Delphi study, the biological and laboratory tests, periodically measured for diabetic patients, were identified. In the second phase, according to the American Diabetes Association guideline, the rules for the interpretation of tests were extracted. In the third stage, an observational study was conducted to identify the elements of explanations that were provided by the physician about the results of patients' tests. In the fourth stage, the template messages were designed. In the evaluation phase, 12 diabetic patients assessed the usability of the generated report in two aspects of the visual design and the content. Five indices of apparent attractiveness, ease of comprehension, applicability, description adequacy, and novelty of content was evaluated with a 5-point Likert scale checklist. Results: The results of the Delphi study revealed that routine tests for diabetic patients included three profiles (e.g. blood glucose, blood lipids, and kidney status), with two examinations (e.g. blood pressure and weight). The structure of the report was designed according to the patient physician communication at visit sessions. Each section of the report includes three types of feedback: descriptive, comparative, and conclusive statements. The average age of participants was 56.4 years with 72.1% women. Patients believed that the report was attractive with an average score of 9.3, and evaluated the report's comprehensiveness with an average score of 9.4. The usability (8.3), the information adequacy (8.7) and the novelty (8.2) were also perceived acceptable by patients. Conclusion: The results showed that the report was acceptable from the perspective of diabetic patients, and patients would like to get more information about their health status. The findings of this study can be used as guidance to design of the next phase of the study, e.g. evaluation of intervention effectiveness