糖尿病自我照護應用程式(app)的易用性對於使用者相當重要，尤其是對於有健康照護需求者和年長者。本論文先對智慧型手機的糖尿病自我照護應用程式做易用性測試，發現程式中按鈕和鍵盤設計對於正確數值輸入的重要性。先前觸控螢幕的數字鍵盤設計研究多著重較大型觸控螢幕，因此實驗二和實驗三檢視對於智慧型手機最佳的鍵盤設計，分別提出適合青年和年長使用者的數字鍵盤配置。
實驗一以易用性測試與問卷評估三款糖尿病自我照護應用程式。分別使用各應用程式完成三個任務後，參與者用系統易用性量表 (SUS) 評估對於應用程式的整體易用性。高 SUS 得分、參與者在放聲思考中強調的介面優勢、與使用者介面可作為自我照護應用程式的設計參考，以達到更高的易用性。實驗進一步檢視輸入數據用的數字鍵盤。實驗二和三的目的是推薦適用於青年和年長者不同的鍵盤設計，因此實驗二和三調查智慧型手機數字鍵盤設計特徵(包括形狀，尺寸，間距)對於主觀表現和客觀使用者滿意度的影響。實驗二和三評估由三種按鍵形狀 (圓形、垂直矩形、正方形)，五種按鍵尺寸(高度7.5、10、12.5、15、17.5公釐)，以及三個按鍵間距 (0、1、3公釐)所組成的45 款不同數字鍵盤配置。實驗二顯示青年使用者的表現於12.5公釐達到平穩狀態，且3公釐間距的錯誤率顯著高於0公釐。實驗三顯示年長者採用15公釐按鍵可有效增進數字輸入的速度和正確度，而3公釐間距可增進輸入速度。實驗二和三結果顯示，圓形和正方形按鍵的表現都顯著優於垂直矩形。而圓形和正方形兩者無顯著差異。研究發現可作為健康照護應用程式和智慧手機數字鍵盤最佳的使用者介面設計參考，後續研究可探討適合年長者的介面，照顧年長使用者族群。

The usability of diabetes self-care app is important to users, especially to the elderly and those with healthcare needs. This study first conducted usability testing of diabetes self-care smartphone apps and found that button and keypad design in those apps were important to correct input of numbers. Previous studies on numeric keypad design were mainly conducted on larger kiosk-sized touchscreens; therefore, the second and third experiments of this study examined the optimal keypad design for smartphones. Two keypad layouts were proposed for young adults and elderly users.
Experiment I evaluated three diabetes self-care apps through usability testing and questionnaire. Operating each app, participants performed three task scenarios, followed by a System Usability Scale (SUS) questionnaire to evaluate overall usability of the app. A high SUS score, advantages highlighted by participants via think-aloud protocol, and the user interface may serve as a reference for diabetes self-care app design to attain a higher level of usability. Following the evaluation of apps, the experiments further examined the use of the numeric keypad for data entry. The objective of the second and third experiment is to recommend different numeric keypad designs suitable for young adults and elderly users. Therefore, experiment II and III investigates objective performance and subjective user satisfaction based on the effects of smartphone numeric button design characteristics including shape, size, and spacing. Experiment II and III evaluated the 45 numeric keypad configurations comprised of three button shapes (circle, vertical rectangle, square), five buttons sizes with 2.5 mm increments (7.5, 10, 12.5, 15, 17.5 mm), and three button spacings (0, 1, 3 mm). Experiment II indicated that young adult user performance plateaued at the 12.5 mm size button. The 3 mm spacing error rate was significantly greater than the 0 mm spacing. Experiment III showed that the 15 mm size improved the entry speed and accuracy of elderly users, and the 3 mm spacing supported a faster entry speed. In experiments II and III, the circle and square buttons resulted in significantly better performance compared to the vertical rectangle button, while the circle and square buttons did not have significant difference. The findings can be used when designing an optimal user interface for healthcare apps and smartphone numeric keypad designs, especially for elderly users.

American Diabetes Association, 2022. Introduction: Standards of Medical Care in Diabetes-2022. Diabetes Care 45, S1-s2.
Aikens, J.E., Zivin, K., Trivedi, R., Piette, J.D., 2014. Diabetes self-management support using mHealth and enhanced informal caregiving. Journal of Diabetes and its Complications 28, 171-176.
Alavi, M.V., 2016. Aging and vision. Advances in experimental medicine and biology 854, 393-399.
Alberti, K.G.M.M., Zimmet, P.Z., 1998. Definition, diagnosis and classification of diabetes mellitus and its complications. Part 1: diagnosis and classification of diabetes mellitus. Provisional report of a WHO Consultation. Diabetic Medicine 15, 539-553.
Armand, J.T., Redick, T.S., Poulsen, J.R., 2014. Task-Specific Performance Effects with Different Numeric Keypad Layouts. Applied Ergonomics 45, 917-922.
Arnhold, M., Quade, M., Kirch, W., 2014. Mobile applications for diabetics: a systematic review and expert-based usability evaluation considering the special requirements of diabetes patients age 50 years or older. J Med Internet Res 16, e104-e104.
Bangor, A., Kortum, P., Miller, J., 2009. Determining What Individual SUS Scores Mean: Adding an Adjective Rating Scale.
Basilico, A., Marceglia, S., Bonacina, S., Pinciroli, F., 2016. Advising patients on selecting trustful apps for diabetes self-care. Computers in Biology and Medicine 71, 86-96.
Beringer, D.B., 1990. Target Size, Location, Sampling Point and Instructional Set: More Effects on Touch Panel Operation. Proceedings of the Human Factors Society Annual Meeting 34, 375-379.
Bjork, C., 2018. Integrating Usability Testing with Digital Rhetoric in OWI. Computers and Composition 49, 4-13.
Brooke, J., 2013. SUS: a retrospective. J. Usability Studies 8, 29-40.
Brzan, P.P., Rotman, E., Pajnkihar, M., Klanjsek, P., 2016. Mobile applications for control and self management of diabetes: a systematic review. Journal of medical systems 40, 210.
Castilla, D., Botella, C., Miralles, I., Bretón-López, J., Dragomir-Davis, A.M., Zaragoza, I., Garcia-Palacios, A., 2018. Teaching digital literacy skills to the elderly using a social network with linear navigation: A case study in a rural area. International Journal of Human-Computer Studies 118, 24-37.
Chang, H.-T., Tsai, T.-H., Chang, Y.-C., Chang, Y.-M., 2014. Touch Panel Usability of Elderly and Children. Computers in Human Behavior 37, 258-269.
Chen, K.B., Savage, A.B., Chourasia, A.O., Wiegmann, D.A., Sesto, M.E., 2013. Touch screen performance by individuals with and without motor control disabilities. Applied Ergonomics 44, 297-302.
Chourasia, A.O., Wiegmann, D.A., Chen, K.B., Irwin, C.B., Sesto, M.E., 2013. Effect of sitting or standing on touch screen performance and touch characteristics. Human Factors 55, 789-802.
Chrimes, D., Kitos, N.R., Kushniruk, A., Mann, D.M., 2014. Usability testing of Avoiding Diabetes Thru Action Plan Targeting (ADAPT) decision support for integrating care-based counseling of pre-diabetes in an electronic health record. International Journal of Medical Informatics 83, 636-647.
Chung, M.K., Kim, D., Na, S., Lee, D., 2010. Usability evaluation of numeric entry tasks on keypad type and age. International Journal of Industrial Ergonomics 40, 97-105.
Colle, H.A., Hiszem, K.J., 2004. Standing at a kiosk: effects of key size and spacing on touch screen numeric keypad performance and user preference. Ergonomics 47, 1406-1423.
Conradi, J., Busch, O., Alexander, T., 2015. Optimal Touch Button Size for the use of Mobile Devices while Walking. Procedia Manufacturing 3, 387-394.
Davis, D., Jiang, S., 2016. Usability testing of existing type 2 diabetes mellitus websites. International Journal of Medical Informatics 92, 62-72.
Fischer, S.H., David, D., Crotty, B.H., Dierks, M., Safran, C., 2014. Acceptance and use of health information technology by community-dwelling elders. International Journal of Medical Informatics 83, 624-635.
Fitts, P.M., 1954. The information capacity of the human motor system in controlling the amplitude of movement. Journal of Experimental Psychology 47, 381-391.
Fu, H., McMahon, S.K., Gross, C.R., Adam, T.J., Wyman, J.F., 2017. Usability and clinical efficacy of diabetes mobile applications for adults with type 2 diabetes: A systematic review. Diabetes Research and Clinical Practice 131, 70-81.
Fung, R.H.Y., Chiu, D.K.W., Ko, E.H.T., Ho, K.K.W., Lo, P., 2016. Heuristic Usability Evaluation of University of Hong Kong Libraries' Mobile Website. The Journal of Academic Librarianship 42, 581-594.
Gao, Q., Sun, Q., 2015. Examining the usability of touch screen gestures for older and younger adults. Human Factors 57, 835-863.
Georgsson, M., Staggers, N., 2016. An evaluation of patients’ experienced usability of a diabetes mHealth system using a multi-method approach. Journal of Biomedical Informatics 59, 115-129.
Heo, J., Ham, D.-H., Park, S., Song, C., Yoon, W.C., 2009. A Framework for Evaluating the Usability of Mobile Phones based on Multi-Level, Hierarchical Model of Usability Factors. Interacting with Computers 21, 263-275.
Hermawati, S., Lawson, G., 2016. Establishing usability heuristics for heuristics evaluation in a specific domain: Is there a consensus? Applied Ergonomics 56, 34-51.
Hertzum, M., Hornbæk, K., 2010. How age affects pointing with mouse and touchpad: a comparison of young, adult, and elderly users. International Journal of Human–Computer Interaction 26, 703-734.
Hoehle, H., Aljafari, R., Venkatesh, V., 2016. Leveraging Microsoft׳s mobile usability guidelines: Conceptualizing and developing scales for mobile application usability. International Journal of Human-Computer Studies 89, 35-53.
Hoppe, C.D., Cade, J.E., Carter, M., 2017. An evaluation of diabetes targeted apps for Android smartphone in relation to behaviour change techniques. 30, 326-338.
Hwangbo, H., Yoon, S.H., Jin, B.S., Han, Y.S., Ji, Y.G., 2013. A study of pointing performance of elderly users on smartphones. International Journal of Human–Computer Interaction 29, 604-618.
Innes, R.J., Howard, Z.L., Thorpe, A., Eidels, A., Brown, S.D., 2020. The effects of increased visual information on cognitive workload in a helicopter simulator. Human Factors 0, 0018720820945409.
Jin, Z.X., Plocher, T., Kiff, L., 2007. Touch screen user interfaces for older adults: button size and spacing, in: (eds), S.C. (Ed.), UAHCI 2007. Lecture Notes in Computer Science, vol 4554. Springer Berlin Heidelberg, Springer, Berlin, Heidelberg. https://doi.org/10.1007/978-3-540-73279-2_104, pp. 933-941.
Jung, E.S., Im, Y., 2015. Touchable area: An empirical study on design approach considering perception size and touch input behavior. International Journal of Industrial Ergonomics 49, 21-30.
Karduck, J., Chapman-Novakofski, K., 2018. Results of the Clinician Apps Survey, How Clinicians Working With Patients With Diabetes and Obesity Use Mobile Health Apps. Journal of Nutrition Education and Behavior 50, 62-69.e61.
Khajouei, R., Hajesmaeel Gohari, S., Mirzaee, M., 2018. Comparison of two heuristic evaluation methods for evaluating the usability of health information systems. Journal of Biomedical Informatics 80, 37-42.
Khansa, L., Davis, Z., Davis, H., Chin, A., Irvine, H., Nichols, L., Lang, J.A., MacMichael, N., 2016. Health information technologies for patients with diabetes. Technology in Society 44, 1-9.
Kim, H., Kwon, S., Heo, J., Lee, H., Chung, M.K., 2014. The effect of touch-key size on the usability of in-vehicle information systems and driving safety during simulated driving. Applied Ergonomics 45, 379-388.
Kim, M.S., Aro, M.R., Lage, K.J., Ingalls, K.L., Sindhwani, V., Markey, M.K., 2016. Exploring the Usability of Mobile Apps Supporting Radiologists' Training in Diagnostic Decision Making. Journal of the American College of Radiology : JACR 13, 335-343.
Leung, E., Wongrakpanich, S., Munshi, M.N., 2018. Diabetes management in the elderly. Diabetes Spectrum 31, 245.
Maramba, I., Chatterjee, A., Newman, C., 2019. Methods of usability testing in the development of eHealth applications: A scoping review. International Journal of Medical Informatics 126, 95-104.
Martin, G.L., 1988. Configuring a numeric keypad for a touch screen. Ergonomics 31, 945-953.
Mosa, A.S.M., Yoo, I., Sheets, L., 2012. A systematic review of healthcare applications for smartphones. BMC Med Inform Decis Mak 12, 67-67.
Nanayakkara, N., Ranasinha, S., Gadowski, A., Heritier, S., Flack, J.R., Wischer, N., Wong, J., Zoungas, S., 2018. Age, age at diagnosis and diabetes duration are all associated with vascular complications in type 2 diabetes. Journal of Diabetes and its Complications 32, 279-290.
Nielsen, J., 1994. Usability Engineering. Morgan Kaufmann Publishers Inc.
Norman, G., 2010. Likert scales, levels of measurement and the “laws” of statistics. Advances in Health Sciences Education 15, 625-632.
Orphanides, A.K., Nam, C.S., 2017. Touchscreen Interfaces in Context: A Systematic Review of Research into Touchscreens Across Settings, Populations, and Implementations. Applied Ergonomics 61, 116-143.
Paglialonga, A., Lugo, A., Santoro, E., 2018. An overview on the emerging area of identification, characterization, and assessment of health apps. Journal of Biomedical Informatics 83, 97-102.
Park, J., H. Han, S., Kim, H.K., Oh, S., Moon, H., 2013. Modeling User Experience: A Case Study on a Mobile Device.
Park, J., Han, S.H., 2013. Defining user value: A case study of a smartphone. International Journal of Industrial Ergonomics 43, 274-282.
Park, Y.S., Han, S.H., 2010. Touch key design for one-handed thumb interaction with a mobile phone: effects of touch key size and touch key location. International Journal of Industrial Ergonomics 40, 68-76.
Petrovčič, A., Taipale, S., Rogelj, A., Dolnicar, V., 2017. Design of mobile phones for older adults: an empirical analysis of design guidelines and checklists for feature phones and smartphones. International Journal of Human-Computer Interaction 34.
Rose, K.J., Petrut, C., L'Heveder, R., de Sabata, S., 2019. IDF Europe's position on mobile applications in diabetes. Diabetes Research and Clinical Practice 149, 39-46.
Saeedi, P., Petersohn, I., Salpea, P., Malanda, B., Karuranga, S., Unwin, N., Colagiuri, S., Guariguata, L., Motala, A.A., Ogurtsova, K., Shaw, J.E., Bright, D., Williams, R., 2019. Global and regional diabetes prevalence estimates for 2019 and projections for 2030 and 2045: Results from the International Diabetes Federation Diabetes Atlas, 9(th) edition. Diabetes Res Clin Pract 157, 107843.
Salman, H.M., Ahmad, W.F.W., Sulaiman, S., 2018. Usability evaluation of the smartphone user interface in supporting elderly users from experts’ perspective. IEEE Access 6, 22578-22591.
Savoy, A., Militello, L.G., Patel, H., Flanagan, M.E., Russ, A.L., Daggy, J.K., Weiner, M., Saleem, J.J., 2018. A cognitive systems engineering design approach to improve the usability of electronic order forms for medical consultation. Journal of Biomedical Informatics 85, 138-148.
Schedlbauer, M., 2007. Effects of Key Size and Spacing on the Completion Time and Accuracy of Input Tasks on Soft Keypads Using Trackball and Touch Input. Proceedings of the Human Factors and Ergonomics Society Annual Meeting 51, 429-433.
Scott, B., Conzola, V., 1997. Designing touch screen numeric keypads: effects of finger size, key size, and key spacing. Proceedings of the Human Factors and Ergonomics Society Annual Meeting 41, 360-364.
Sears, A., 1991. Improving touchscreen keyboards: design issues and a comparison with other devices. Interacting with Computers 3, 253-269.
Sears, A., Zha, Y., 2003. Data Entry for Mobile Devices Using Soft Keyboards: Understanding the Effects of Keyboard Size and User Tasks. International Journal of Human Computer Interaction 16, 163 - 184.
Sesto, M.E., Irwin, C.B., Chen, K.B., Chourasia, A.O., Wiegmann, D.A., 2012. Effect of touch screen button size and spacing on touch characteristics of users with and without disabilities. 54, 425-436.
Shen, Z., Zhang, L., Li, R., Liang, R., 2020. The effects of icon internal characteristics on complex cognition. International Journal of Industrial Ergonomics 79, 102990.
Shinkai, R.S.A., Hatch, J.P., Cornell, J.E., Yeh, C.-K., 2004. Intraoral tactile sensitivity in adults with diabetes. Diabetes Care 27, 869-873.
Sonderegger, A., Schmutz, S., Sauer, J., 2016. The influence of age in usability testing. Applied Ergonomics 52, 291-300.
Stec, M., Arbour, M.W., 2020. Wellness and disease self-management mobile health apps evaluated by the mobile application rating scale. Advances in Family Practice Nursing 2, 87-102.
Sun, H., Saeedi, P., Karuranga, S., Pinkepank, M., Ogurtsova, K., Duncan, B.B., Stein, C., Basit, A., Chan, J.C.N., Mbanya, J.C., Pavkov, M.E., Ramachandaran, A., Wild, S.H., James, S., Herman, W.H., Zhang, P., Bommer, C., Kuo, S., Boyko, E.J., Magliano, D.J., 2021. IDF diabetes Atlas: Global, regional and country-level diabetes prevalence estimates for 2021 and projections for 2045. Diabetes Res Clin Pract, 109119.
Tan, W.-s., Liu, D., Bishu, R., 2009. Web evaluation: Heuristic evaluation vs. user testing. International Journal of Industrial Ergonomics 39, 621-627.
Tang, Z., Jin, X., Wu, Y., Ma, J., Xia, D., Dong, Y., Yang, C., 2021. Ergonomic evaluation of the effects of forearm conditions and body postures on trapezius muscle activity during smartphone texting. International Journal of Industrial Ergonomics 82, 103085.
Tao, D., Yuan, J., Liu, S., Qu, X., 2018. Effects of button design characteristics on performance and perceptions of touchscreen use. International Journal of Industrial Ergonomics 64, 59-68.
Verkuyl, M., Romaniuk, D., Mastrilli, P., 2018. Virtual gaming simulation of a mental health assessment: A usability study. Nurse Education in Practice 31, 83-87.
Wang, A.-H., Lin, H.-Y., Xiao, S.-H., 2020. Effects of text input methods on performance in operating handheld devices between young and elderly users. Displays 65, 101974.
Yoo, S., Jung, S.Y., Kim, S., Kim, E., Lee, K.-H., Chung, E., Hwang, H., 2016. A Personalized Mobile Patient Guide System for a Patient-Centered Smart Hospital: Lessons Learned from a Usability Test and Satisfaction Survey in a Tertiary University Hospital. International Journal of Medical Informatics 91, 20-30.
You, M., Chen, C.-W., Liu, H., Lin, H., 2007. A Usability Evaluation of Web Map Zoom and Pan Functions. International Journal of Design 1, 15-25.