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Bérubé C, Maritsch M, Lehmann VF, Kraus M, Feuerriegel S, Züger T, Wortmann F, Stettler C, Fleisch E, Kocaballi AB, Kowatsch T. Multimodal In-Vehicle Hypoglycemia Warning for Drivers With Type 1 Diabetes: Design and Evaluation in Simulated and Real-World Driving. JMIR Hum Factors 2024; 11:e46967. [PMID: 38635313 PMCID: PMC11066742 DOI: 10.2196/46967] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/08/2023] [Revised: 05/23/2023] [Accepted: 03/02/2024] [Indexed: 04/19/2024] Open
Abstract
BACKGROUND Hypoglycemia threatens cognitive function and driving safety. Previous research investigated in-vehicle voice assistants as hypoglycemia warnings. However, they could startle drivers. To address this, we combine voice warnings with ambient LEDs. OBJECTIVE The study assesses the effect of in-vehicle multimodal warning on emotional reaction and technology acceptance among drivers with type 1 diabetes. METHODS Two studies were conducted, one in simulated driving and the other in real-world driving. A quasi-experimental design included 2 independent variables (blood glucose phase and warning modality) and 1 main dependent variable (emotional reaction). Blood glucose was manipulated via intravenous catheters, and warning modality was manipulated by combining a tablet voice warning app and LEDs. Emotional reaction was measured physiologically via skin conductance response and subjectively with the Affective Slider and tested with a mixed-effect linear model. Secondary outcomes included self-reported technology acceptance. Participants were recruited from Bern University Hospital, Switzerland. RESULTS The simulated and real-world driving studies involved 9 and 10 participants with type 1 diabetes, respectively. Both studies showed significant results in self-reported emotional reactions (P<.001). In simulated driving, neither warning modality nor blood glucose phase significantly affected self-reported arousal, but in real-world driving, both did (F2,68=4.3; P<.05 and F2,76=4.1; P=.03). Warning modality affected self-reported valence in simulated driving (F2,68=3.9; P<.05), while blood glucose phase affected it in real-world driving (F2,76=9.3; P<.001). Skin conductance response did not yield significant results neither in the simulated driving study (modality: F2,68=2.46; P=.09, blood glucose phase: F2,68=0.3; P=.74), nor in the real-world driving study (modality: F2,76=0.8; P=.47, blood glucose phase: F2,76=0.7; P=.5). In both simulated and real-world driving studies, the voice+LED warning modality was the most effective (simulated: mean 3.38, SD 1.06 and real-world: mean 3.5, SD 0.71) and urgent (simulated: mean 3.12, SD 0.64 and real-world: mean 3.6, SD 0.52). Annoyance varied across settings. The standard warning modality was the least effective (simulated: mean 2.25, SD 1.16 and real-world: mean 3.3, SD 1.06) and urgent (simulated: mean 1.88, SD 1.55 and real-world: mean 2.6, SD 1.26) and the most annoying (simulated: mean 2.25, SD 1.16 and real-world: mean 1.7, SD 0.95). In terms of preference, the voice warning modality outperformed the standard warning modality. In simulated driving, the voice+LED warning modality (mean rank 1.5, SD rank 0.82) was preferred over the voice (mean rank 2.2, SD rank 0.6) and standard (mean rank 2.4, SD rank 0.81) warning modalities, while in real-world driving, the voice+LED and voice warning modalities were equally preferred (mean rank 1.8, SD rank 0.79) to the standard warning modality (mean rank 2.4, SD rank 0.84). CONCLUSIONS Despite the mixed results, this paper highlights the potential of implementing voice assistant-based health warnings in cars and advocates for multimodal alerts to enhance hypoglycemia management while driving. TRIAL REGISTRATION ClinicalTrials.gov NCT05183191; https://classic.clinicaltrials.gov/ct2/show/NCT05183191, ClinicalTrials.gov NCT05308095; https://classic.clinicaltrials.gov/ct2/show/NCT05308095.
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Affiliation(s)
- Caterina Bérubé
- Centre for Digital Health Interventions, Department of Management, Technology and Economics, ETH Zurich, Zurich, Switzerland
| | - Martin Maritsch
- Centre for Digital Health Interventions, Department of Management, Technology and Economics, ETH Zurich, Zurich, Switzerland
| | - Vera Franziska Lehmann
- Centre for Digital Health Interventions, Department of Management, Technology and Economics, ETH Zurich, Zurich, Switzerland
- Department of Diabetes, Endocrinology, Nutritional Medicine and Metabolism, Bern University Hospital, University of Bern, Bern, Switzerland
| | - Mathias Kraus
- School of Business, Economics and Society, Friedrich-Alexander-Universit¨at Erlangen-Nürnberg, Nürnberg, Germany
| | - Stefan Feuerriegel
- Centre for Digital Health Interventions, Department of Management, Technology and Economics, ETH Zurich, Zurich, Switzerland
- LMU Munich School of Management, LMU Munich, Munich, Germany
| | - Thomas Züger
- Centre for Digital Health Interventions, Department of Management, Technology and Economics, ETH Zurich, Zurich, Switzerland
- Department of Diabetes, Endocrinology, Nutritional Medicine and Metabolism, Bern University Hospital, University of Bern, Bern, Switzerland
- Department of Endocrinology and Metabolic Diseases, Kantonsspital Olten, Olten, Switzerland
| | - Felix Wortmann
- Centre for Digital Health Interventions, Department of Management, Technology and Economics, ETH Zurich, Zurich, Switzerland
- Institute of Technology Management, University of St.Gallen, St Gallen, Switzerland
| | - Christoph Stettler
- Centre for Digital Health Interventions, Department of Management, Technology and Economics, ETH Zurich, Zurich, Switzerland
- Department of Diabetes, Endocrinology, Nutritional Medicine and Metabolism, Bern University Hospital, University of Bern, Bern, Switzerland
| | - Elgar Fleisch
- Centre for Digital Health Interventions, Department of Management, Technology and Economics, ETH Zurich, Zurich, Switzerland
- Institute of Technology Management, University of St.Gallen, St Gallen, Switzerland
| | - A Baki Kocaballi
- School of Computer Science, University of Technology Sydney, Sydney, Australia
| | - Tobias Kowatsch
- Centre for Digital Health Interventions, Department of Management, Technology and Economics, ETH Zurich, Zurich, Switzerland
- Institute of Technology Management, University of St.Gallen, St Gallen, Switzerland
- Institute for Implementation Science in Health Care, University of Zurich, Zurich, Switzerland
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Maritsch M, Föll S, Lehmann V, Styger N, Bérubé C, Kraus M, Feuerriegel S, Kowatsch T, Züger T, Fleisch E, Wortmann F, Stettler C. Smartwatches for non-invasive hypoglycaemia detection during cognitive and psychomotor stress. Diabetes Obes Metab 2024; 26:1133-1136. [PMID: 38086545 DOI: 10.1111/dom.15402] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/03/2023] [Revised: 11/16/2023] [Accepted: 11/21/2023] [Indexed: 02/06/2024]
Affiliation(s)
- Martin Maritsch
- Department of Management, Technology and Economics, ETH Zurich, Zurich, Switzerland
| | - Simon Föll
- Department of Management, Technology and Economics, ETH Zurich, Zurich, Switzerland
| | - Vera Lehmann
- Department of Diabetes, Endocrinology, Nutritional Medicine and Metabolism, Inselspital, Bern, University Hospital, University of Bern, Bern, Switzerland
| | - Naïma Styger
- Department of Diabetes, Endocrinology, Nutritional Medicine and Metabolism, Inselspital, Bern, University Hospital, University of Bern, Bern, Switzerland
| | - Caterina Bérubé
- Department of Management, Technology and Economics, ETH Zurich, Zurich, Switzerland
| | - Mathias Kraus
- School of Business, Economics and Society, Friedrich-Alexander University Erlangen-Nürnberg, Nürnberg, Germany
| | - Stefan Feuerriegel
- Institute of AI in Management, LMU Munich, Munich, Germany
- Munich Center for Machine Learning (MCML), Munich, Germany
| | - Tobias Kowatsch
- Department of Management, Technology and Economics, ETH Zurich, Zurich, Switzerland
- Institute for Implementation Science in Health Care, University of Zurich, Zurich, Switzerland
- School of Medicine, University of St Gallen, St Gallen, Switzerland
| | - Thomas Züger
- Department of Diabetes, Endocrinology, Nutritional Medicine and Metabolism, Inselspital, Bern, University Hospital, University of Bern, Bern, Switzerland
- Department of Endocrinology and Metabolic Diseases, Kantonsspital Olten, Olten, Switzerland
| | - Elgar Fleisch
- Department of Management, Technology and Economics, ETH Zurich, Zurich, Switzerland
- Institute of Technology Management, University of St Gallen, St Gallen, Switzerland
| | - Felix Wortmann
- Institute of Technology Management, University of St Gallen, St Gallen, Switzerland
| | - Christoph Stettler
- Department of Diabetes, Endocrinology, Nutritional Medicine and Metabolism, Inselspital, Bern, University Hospital, University of Bern, Bern, Switzerland
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