Designing Consumer Health Information Technology to Support Biform and Articulation Work: A Qualitative Study of Diet and Nutrition Management as Patient Work

JMIR Hum Factors. 2021 Aug 10;8(3):e27452. doi: 10.2196/27452.

Courtney C Rogers # 1Thomas J Moutinho Jr 2Xiaoyue Liu 3Rupa S Valdez 1 4


Author information

  • 1Department of Engineering Systems and Environment, University of Virginia, Charlottesville, VA, United States.
  • 2Department of Biomedical Engineering, University of Virginia, Charlottesville, VA, United States.
  • 3School of Nursing, University of Virginia, Charlottesville, VA, United States.
  • 4Department of Public Health Sciences, University of Virginia, Charlottesville, VA, United States.

#Contributed equally.


Background: Diet and nutrition management is an integral component of Crohn disease (CD) management. This type of management is highly variable and individualized and, thus, requires personalized approaches. Consumer health information technology (CHIT) designed to support CD management has typically supported this task as everyday life work and, not necessarily, as illness work. Moreover, CHIT has rarely supported the ways in which diet and nutrition management requires coordination between multiple forms of patient work.

Objective: The purpose of this study was to investigate diet and nutrition management as biform work, identify components of articulation work, and provide guidance on how to design CHIT to support this work.

Methods: We performed a qualitative study in which we recruited participants from CD-related Facebook pages and groups.

Results: Semistructured interviews with 21 individuals showed that diet and nutrition management strategies were highly individualized and variable. Four themes emerged from the data, emphasizing the interactions of diet and nutrition with physical, emotional, information, and technology-enabled management.

Conclusions: This study shows that the extent to which diet and nutrition management is biform work fluctuates over time and that articulation work can be continuous and unplanned. The design guidance specifies the need for patient-facing technologies to support interactions among diet and nutrition and other management activities such as medication intake, stress reduction, and information seeking, as well as to respond to the ways in which diet and nutrition management needs change over time.

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