Creating Learning Tools for Confident Choices

For people living with Type 1 diabetes, everyday decisions can become complex exercises in data interpretation.

Eating a meal, going for a run, or traveling can require weighing multiple variables and anticipating how their blood glucose level might respond. The challenge is not just being aware of facts about their condition. It is knowing which information matters in a particular situation, how the different factors may interact, and what to do when the available information is incomplete.

Cynthia D’Angelo, associate professor of Educational Psychology and Curriculum & Instruction in the College of Education, wants to better understand how people learn to make these decisions and develop training and learning materials to help them do it more effectively.

D’Angelo is leading a four-year, nearly $1.2 million project funded by the National Science Foundation (NSF) to study the complex STEM learning involved in managing Type 1 diabetes, particularly for adults. The project is developing and testing online learning materials and a simulation game designed to help people practice interpreting data, understand relationships among variables and make decisions under uncertainty.

The project approaches diabetes management as a learning problem—one that provides a real-life example of how people use STEM knowledge outside classrooms and laboratories.

“Our goal here is to improve how people learn about their diabetes, and learn how to make decisions around its management,” D’Angelo says. People with Type 1 diabetes, she notes, make management decisions “all day, every day.”

Learning to Navigate Complexity

The project begins with a fundamental challenge: Type 1 diabetes management is a complex system in which people must continually reason with incomplete information.

D’Angelo says the project isn’t focusing its learning material on topics such as the biology of the endocrine system, which are already covered by existing resources. Instead, the researchers are interested in gaps that become apparent when people try to apply knowledge in real situations.

One focus is helping learners think about diabetes as a complex system. “There are dozens of factors that can influence blood glucose, and people often have limited information about many of them,” says D’Angelo. “Those factors can operate over different timescales, in different directions and with different magnitudes.”

The practical question becomes one of attention and reasoning: Which variables matter most right now?

The answer may be different when someone is eating at a restaurant than when they are preparing for a run or traveling. Rather than expecting people to account for every possible variable, researchers want to help learners identify the factors most relevant to the situation in front of them.

Another focus is data literacy. People with Type 1 diabetes encounter data visualizations throughout the day through diabetes-management technologies. The project will explore how learners understand those visualizations, identify meaningful patterns and reason about relationships among variables.

The increasingly sophisticated technology used to manage diabetes creates another learning challenge. Many insulin pumps now incorporate automated systems governed by algorithms. Understanding something about how those algorithms operate, D’Angelo says, can help users decide what information deserves their attention and troubleshoot when something unexpected occurs.

The result is a form of everyday scientific reasoning.

“You have to do a lot of trial and error,” D’Angelo says. “It’s being a scientist for your own health every day.”

The research team wants to determine how that experimentation can be scaffolded so that trial and error becomes an opportunity for learning. Someone who repeatedly encounters difficulty managing blood glucose around lunch, for example, could learn how to isolate a problem, collect relevant information, test a change and use the resulting data productively rather than simply trying different approaches without having a framework to help them understand what happened.

From a Model of Learning to a Simulation

Those challenges inform three interconnected aims for the NSF project.

First, researchers will refine a knowledge model for how people make sense of incomplete data in an uncertain, complex system. Second, they will develop and test online STEM learning materials designed around the needs of adults with Type 1 diabetes. Third, they will develop and test a simulation or game in which learners can practice STEM skills including data interpretation, reasoning about relationships among variables, and understanding uncertainty.

Technology-enhanced learning is particularly promising, because simulations give learners opportunities to engage with interconnected variables and practice decision-making without having to wait for a similar situation to occur in daily life.

Developing these resources will be an iterative process. Collaborator Catherine Dornfeld Tissenbaum, assistant professor of Curriculum & Instruction, is contributing expertise in design-based research methodology. As the team develops the online materials and simulation, they’re using feedback from focus groups as well as log data generated by the online products to move through cycles of testing and revision. Dornfeld Tissenbaum is helping document what the researchers change and why, as well as how each decision connects to evidence gathered during the design process. This documentation will help the project produce knowledge beyond the learning tools themselves and show how the design evolved in response to learners.

The project also builds on a partnership with the nonprofit Beta Cell Foundation, devoted to Type 1 Diabetes education built by people living with the condition. The relationship began several years ago, when D’Angelo connected with the organization as it explored opportunities to develop educational resources. Beta Cell Foundation helped D’Angelo recruit about 200 adult survey participants that provided pilot data to shape the successful NSF proposal.

Filling the Gap Between General Knowledge and Specialized Advice

The project is grounded in the idea that access to information alone does not necessarily produce effective learning. Books, websites and social media already offer substantial amounts of information about Type 1 diabetes. But D’Angelo sees a need for resources informed by research on how people learn and organized around the changing questions people encounter over time.

“Someone newly diagnosed may need foundational knowledge immediately,” she says. “Months or years later, that same person might have more specialized questions, like ‘how can I safely train for a half marathon?’ or ‘how should I approach pregnancy?’ or ‘how do I manage a new or unfamiliar situation?’”

Existing sources can leave learners caught between two extremes. Medical professionals may offer advice that is necessarily general, D’Angelo says, while advice found on social media or online forums can be highly specific to another person's experience. She says what’s missing is a middle ground that combines knowledge of Type 1 diabetes and an understanding of living with the condition from day to day, delivered with solid pedagogy.

The NSF project is designed to help build that middle ground.

Its emphasis on informal learning is significant because people need information in the contexts where decisions occur and in the ways they’re comfortable receiving information: whether online, from peers, or on demand.

A Project Informed by Lived Experience

For D’Angelo, this project is also personal.

She was diagnosed with Type 1 diabetes as an adult in her 30s, and her experience quickly revealed what she saw as a gap in educational support for those who receive the diagnosis in adulthood. Annually, about 45,000 individuals in the U.S. are diagnosed with Type 1 diabetes as adults.

Children diagnosed with Type 1 diabetes, because of its acute onset, often spend several days in a hospital environment where education begins immediately and family members can help manage the transition. D’Angelo's own hospitalization lasted only overnight.

Adults, she says, often lack the same initial support structure even though they must rapidly learn information essential to managing the condition.

“When I was diagnosed, literally, they gave me a pamphlet and were like, ‘good luck, see you in a month,’” she recalls.

As a researcher, D’Angelo knew how to find trustworthy resources and evaluate scientific information. Her professional expertise in learning also gave her a way to recognize the experience as more than an information deficit. Her experience led to the question now at the center of the NSF project: What does someone actually need to learn to make sense of a complicated, uncertain system, and how can that learning be supported?

“I wanted to study the learning part of this,” D’Angelo says. “Because I think that's the really interesting problem.”

She’s strategizing ways the resources created through this project will remain freely available to the public after the grant period expires. Ultimately, the goal is to give individuals stronger tools for making decisions and, potentially, greater confidence and freedom to navigate situations that might otherwise feel too complicated to explore.