Mobile Application for Real-Time Food Plan Management for Alzheimer Patients through Design-Based Research
Round 1
Reviewer 1 Report
This paper describes the design and development of a mobile application to monitor and control the food plans of Alzheimer’s patients, using a user-centered design. The paper is interesting but there are some major flaws that need to be addressed.
Major notes:
- The Related Work section has to be expanded, adding more details of the related work and presenting some more ones
- The System architecture should be better detailed and Figure 1 should highlight at least a common database
- The authors should divide the functional requirements from the non-functional or
- Should the caregiver also report on the time when the patient eats/drinks?
- The authors should add a discussion on the proposed system highlighting its main limitations
Minor notes:
- The text in Figure 1 is difficult to read
- A proofread is needed to correct errors and typos
A proofread is needed to correct errors and typos
Author Response
We are delighted with the comments provided by the reviewer. They helped us to improve the paper and the results. In the following, we present some comments on the questions raised.
- The Related Work section has to be expanded, adding more details of the related work and presenting some more ones
We appreciate the suggestion and improved this section. A new table is created with the comparison with the features of interest for apps that meet most criteria. Many other apps are available; however, they lack on several features and are not interesting (due to lack of features) to include in the analysis.
- The System architecture should be better detailed and Figure 1 should highlight at least a common database
We have detailed the description of the system architecture, and the database used in the implementation is added to Figure 1. Moreover, the server requests of the application were presented in a Figure in a new Appendix.
- Should the caregiver also report on the time when the patient eats/drinks?
Thank you for the question. In this context, it is important to consider that good hydration is one of the most important aspects to consider in Alzheimer disease. Therefore, it becomes critical to reach the daily goal of water intake. Adding time of water intake would be a feature that would increase the interaction time and would not add much value to the system.
The same applies for the meals, since the nutritionist prescribes a meal that has not a specific moment to be ingested – it must occur within the meal period, but not in a specific moment. Therefore, there is no need to register the time.
- The authors should add a discussion on the proposed system highlighting its main limitations
We have added limitations to the conclusions.
- The text in Figure 1 is difficult to read
We have increased the size of the source and made some readjustments to Figure 1.
- A proofread is needed to correct errors and typos
We have reviewed the entire paper and corrected some of the typos and English writing.
Reviewer 2 Report
This paper concerns an important domain: the developement and the evaluation of a user interface of a mobile app dedicated to caregivers of patients with Alzeimer's disease. The objective of this app is to allow Real-Time Food Plan Management.
Twenty participants are involved in the study. They are aged between 60 and 70 (playing the role of caregivers). It is relevant for such a study. The results obtained are very promising showing the interest and the potentialities of the app.
The paper is very clear. The concepts and characteristics/consequences concerning Alzeimer's disease can be well understood by the readers. There are many very good and clear illustrations.
It is possible to improve the paper. My remarks are the following:
- At the end of Section 2, a synthesis is lacking. I suggest to add a Table allowing to globally compare the main characteristics of the current apps (according with several well chosen criteria). This synthesis must allow to understand well this concluding sentence: "The work presented in this paper aims at filling a gap in the aforementioned applications/research by including the control of the prescribed food in the meals and providing real-time feedback to the nutritionist."
- The reference 39 about User-Centered-Design is old (but relevant) and not sufficient. I suggest to add a reference to the ISO standard:
ISO (2019). ISO 9241-210: 2019 Ergonomics of human-system interaction - Part 210: human-centred design for interactive systems.
- In Section 3.1, the authors write: "In the first stage, several meetings took place with therapists and nutritionists" => how many meetings? How many participants?
- The authors should justify why there was no meeting involving caregivers. Indeed, in a user-centered approach, it is relevant and necessary to involve representatives of each category of users.
- Justify the use of UEQ. What where the alternatives?
- Reference 42 (Desmet et al.) is a surprising second reference related to Cognitive Walkthrough. As second reference (associated to Rieman et al., I would suggest:
Mahatody, T.; Sagar; M.; Kolski, C. State of the Art on the Cognitive Walkthrough method, its variants and evolutions. International Journal of Human-Computer Interaction, 26 (8), pp. 741-785, 2010.
- Would it be possible to provide information about the global duration of the tasks to perform? (linked to Table 1)
- In Table 1: It is not easy to understand why there is no process for Tast 9 (explain what there is to do).
- In Figure 1: "Creates Food Plan" => "Create Food Plan" (check the use of "s")
- When "Plate Model [49]" appears, it would be relevant to provide (conceptual or theoretical) explanations about this mode which is important for this paper.
- In Figure 7, the algorithm should have a stop test (to avoid an infinite loop)
- I suggest to increase the size of Figure A1.
Author Response
We are delighted with the comments provided by the reviewer. They helped us to improve the paper and the results. In the following, we present some comments on the questions raised.
- At the end of Section 2, a synthesis is lacking. I suggest to add a Table allowing to globally compare the main characteristics of the current apps (according with several well chosen criteria). This synthesis must allow to understand well this concluding sentence: "The work presented in this paper aims at filling a gap in the aforementioned applications/research by including the control of the prescribed food in the meals and providing real-time feedback to the nutritionist."
We appreciate the suggestion and improve this section. A new table is created with the comparison with the features of interest for apps that meet most criteria. Many other apps are available; however, they lack on several features and are not interesting to include in the analysis.
- The reference 39 about User-Centered-Design is old (but relevant) and not sufficient. I suggest to add a reference to the ISO standard:
ISO (2019). ISO 9241-210: 2019 Ergonomics of human-system interaction - Part 210: human-centred design for interactive systems.
We appreciate the suggestion and add the reference to the paper.
- In Section 3.1, the authors write: "In the first stage, several meetings took place with therapists and nutritionists" => how many meetings? How many participants?
For the context of identification of requirements, we arranged separate meetings with the different stakeholders. 3 meetings with therapists and caregivers (4 therapists and 3 caregivers); 3 meetings with nutritionists (2 nutritionists).
- The authors should justify why there was no meeting involving caregivers. Indeed, in a user-centered approach, it is relevant and necessary to involve representatives of each category of users.
In fact, we have done that. Our intention to have the minimum impact on caregivers’ routines and busy schedules. That is why we resorted to several particular and public hospitals to arrange meetings with therapists and invited caregivers (through therapists) at this stage. One of our concerns was the availability of caregivers for UI testing, and we choose to reduce the number of caregivers in meetings to be able to invite them for the interface test and analysis. We add this information (as is) in the paper.
- Justify the use of UEQ. What where the alternatives?
There are several approaches available in the literature (depending also on the approach that is to be taken – empirical or analytical). In this paper we have focused on empirical methods for task-level satisfaction. With focus on the target group and the metrics to be extracted, our intent was to measure the feelings of caregivers to the UI and task competition. We would like to refer that most of these caregivers have low technological background, so the approach had to be complex (with a valid and scientific approach), but easy to understand. And the UEQ is a good approach fo this, since it focuses the analysis in characteristics of the system, using familiar terms.
- Reference 42 (Desmet et al.) is a surprising second reference related to Cognitive Walkthrough. As second reference (associated to Rieman et al., I would suggest:
Mahatody, T.; Sagar; M.; Kolski, C. State of the Art on the Cognitive Walkthrough method, its variants and evolutions. International Journal of Human-Computer Interaction, 26 (8), pp. 741-785, 2010.
We appreciate the correction. The provided reference (Desmet et al.) is completely out of context and was misplaced.
- Would it be possible to provide information about the global duration of the tasks to perform? (linked to Table 1)
We appreciate the question and took a different approach. We have added, in the Evaluation section, a new table regarding the average execution times of users, for each of the tasks.
- In Table 1: It is not easy to understand why there is no process for Tast 9 (explain what there is to do).
We focused the analysis of the natural process in a real context action. The measure of macronutrients is not self-explained. However, it can be interpreted as the ingestion of all (or parts) of food. Naturally there is a greater margin for error in the perception of the ingestion. However, the mental process associated can be replaced with the concept in “ingestion of all (or parts) of food”, and the table is now updated.
- In Figure 1: "Creates Food Plan" => "Create Food Plan" (check the use of "s")
We also noticed that the context of Patient/Caregiver was also with extra “s”, and changed it also.
- When “Plate Model [49]” appears, it would be relevant to provide (conceptual or theoretical) explanations about this mode which is important for this paper.
We have added a description of the model in the section where the reference is presented and contextualized it with the problem to solve.
- In Figure 7, the algorithm should have a stop test (to avoid an infinite loop)
From our perception and after reviewing the implementation, there is no infinite loop, since the food (fi) in a meal is from a finite set of values. Therefore, the occurrence of an infinite loop is not a possibility.
- I suggest to increase the size of Figure A1.
Figure 1 is now in page width, which increases its size.
Reviewer 3 Report
This is a very interesting paper well introduced, documented and presented. The objective to design an appropriate User Interface for IC (Informal Care givers) is obtained by the use of UCD (User Centered Design) and evaluated by User Experience Questionnaire. State of the art references are appropriate, as well as figures illustrating different aspects of proposed User Interface. In the conclusion, next steps are appropriately expressed.
Author Response
We appreciate the review.
Round 2
Reviewer 1 Report
The authors well addressed the raised issues
Reviewer 2 Report
The remarks have been taken seriously into account by the authors. I appreciate this revised version. This paper is really interesting. I propose it to be accepted.
Minor remark:
- In Figure 1 (below "Manage appointment"):
"Creates Food Plan" => "Create Food Plan" (check the use of "s")
