Too Many Conditions, Too Little Time: Designing Technological Interventions for Patients with Type-2 Diabetes and Discordant Chronic Comorbidities Tom Ongwere 1 , Gabrielle Cantor 1 , Sergio Ramirez Martin 2 , Patrick C. Shih 1 , James Clawson 1 , Kay Connelly 1 1 Indiana University, Bloomington, Indiana, United States; 2 Transylvania University, Lexington, Kentucky, United States Abstract Patients with Discordant Chronic Comorbidities (DCCs) either are experiencing multiple conditions that are not re- lated in their treatment plans and management, or are dealing with the simultaneous presence of two or more chronic illnesses with opposing treatment instructions. These conditions can make it difficult for patients and health- care providers to prioritize and manage the treatment of each individual disease. Some difficulties that arise from having DCCs include medication conflicts, social and familial dependencies, seeing multiple health care providers, and man- aging multiple treatments simultaneously. This paper highlights barriers faced by patients with type 2 diabetes and either depression or arthritis, describes a design process, and presents a design of a digital tool to support patients with DCCs in managing their health. The design ideas presented in this work were influenced by the health care management needs, barriers and opportunities suggested by patients with type 2 diabetes and DCCs. Introduction and Background Chronic conditions are conditions that last five or more months, such as diabetes, arthritis, and depression. Due to the extended nature of these conditions, patients typically are entrusted to play an active role in their treatments and management; however, they often require complex treatment and management routines. Patients frequently struggle to successfully achieve and/or maintain these routines, increasing their risk of developing other additional chronic conditions or severe health outcomes 1–4 . Discordant chronic comorbidities (DCCs) are conditions in which treatment guidelines are not related 2 , or even conflicting, creating difficulties for providers and patients when it comes to manag- ing their conditions. Despite the increased numbers of patients with DCCs, few studies have looked into understanding the needs and challenges these patients face 1 ; furthermore, there is a shortage of tools to aid individuals with DCCs in managing their health and wellness. In this paper, we present the design of a tool to help individuals with DCCs better manage their overall health and well being. Over 28 million people in the US have type-2 diabetes 5 . The majority of patients with type-2 diabetes have at least 1 additional chronic condition with approximately 40% have 3 or more chronic conditions 6 . These patients often need frequent general practice consultations, complex and structured care, as well as increased coordination between different health care providers to ensure the better quality of care 4, 7 . In our prior work, we performed a photo elicitation interview (PEI) study with 15 patients with type-2 diabetes and a DCC (either arthritis or depression) 8 . We identified a set of barriers participants face when it comes to managing their conditions, and solutions they have developed to address their needs 8 . While these exist numerous applications to support people in managing their health, (e.g., wearable devices 9 , jour- nals 10 , goal setting 11 , rewards 10, 12 and social sharing 13 ), most of these applications were purposefully designed for patients with a single chronic condition or to achieve a single task (e.g. track physical activity routines or eating habits, or monitoring their physiological data such as heart rates and sleep patterns). Patients with DCCs typically face a multitude of tasks and routines, making these single-focus applications fall short in meeting their needs. Doyle et al. and Sinnott et al. separately explore how to encourage patients with multiple conditions adhere to complex medication management routines 14, 15 . We use their work to inform the medication management portion of our design. However, their guidelines did not specifically address patients with discordant comorbidities, so may not sufficiently address the challenges associated with DCCs. This paper presents a design case study which incorporates the findings from the literature and our prior work to address the complex needs of patients with type-2 diabetes and a DCC. We start with an overview of the most relevant findings of our previous photo elicitation interview (PEI) study of patients with DCCs. We then briefly present the