Consumer Biosensor Devices: Technology, User Interface, and Social Media

CONSUMER BIOSENSOR DEVICES: TECHNOLOGY, USER INTERFACE, SOCIAL MEDIA

Consumer Biosensor Devices:

Technology, User Interface, and Social Media

Joseph Roberson

University of Maryland, Baltimore County

The Adult Learner 605 Dr. Chuck Hodell April 3, 2013

BIOSENSOR DEVICES: TECHNOLOGY, USER INTERFACE, SOCIAL MEDIA

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Abstract This research paper surveys the field of biosensor devices (also known as activity trackers), distinguishing different devices designed for different user populations (consumer, patient, soldier, athlete, yogi). After this overall survey, the focus narrows to devices designed for the consumer market. The consumer-‐oriented device is considered to consist of three elements: what the device measures, its design and user interface, and attendant social media elements. One consumer device, the FitBit One, is discussed in detail for how its design, interface, and social media engage and encourage the ‘adult learner’ who is attempting to lose weight by changing habits of exercising and eating. The different strategies and tactics pursued by these adults are viewed through relevant principles of Andragogy.


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May 12, 2013

Copyright © 2013 Joseph Roberson


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Table of Contents

Abstract .......................................................................................................................................... ii

Table of Contents .......................................................................................................................... iv

Introduction .................................................................................................................................... 1

Different Markets, Different Objectives, Different Devices ........................................................... 2

Consumer “Activity Trackers” ........................................................................................................ 4

Form Factor/Design, User Interface/User Experience Design, and Social Media .................. 4

FitBit One: Personal Trainer Replacement? ........................................................................... 5

Activity trackers, weight loss and the adult learner ....................................................................... 9

Conclusion .................................................................................................................................... 11


1

Introduction Habits are a particularly difficult type of behavior for many adults to learn or unlearn.

One way that adult learners are different from children learners is in the accumulated inertia of habits. Being overweight is the result of two habits: eating too much while exercising too little. This combination of too many calories in and too few calories out is so prevalent in the USA it is now an epidemic of obesity, a growing epidemic with serious health consequences.

There are multiple factors driving this epidemic, including lower nutritional value of readily available foods, decreased time available for preparing food and sharing meals with family and friends, increased stress, as well as sedentary jobs and lifestyles. Within this complex mix of forces, many individuals are striving to lose weight by regulating their behavior– by exercising more and eating less and/or better food.

It is a truism that you cannot change what you cannot measure: biosensor devices measure and record physical activity, calculate calories burned, and some have provision for logging food (calorie) intake. The rapidly growing market for activity trackers, as consumer biosensor devices are known, seems to be a natural response to this ‘need for learning’ among adults striving to burn more calories while consuming fewer. But this is not enough for many adults to significantly alter their behavior for a sustained time. Adults need social support, peer pressure, and encouragement1; they need to publicly declare their intention to lose weight and then be held accountable. If all learning is social2, then habit change, being a particularly challenging type of learning, seems doubly dependent on social support.

The most savvy of the companies selling activity trackers provide these social learning elements by way of online communities with user forums, public groups, public challenges, and badges to reward achievements. The gadget becomes, in effect, an entry token granting membership into a learning community.

1 1 http://www.northwestern.edu/newscenter/stories/2012/12/mobile-‐app-‐boosts-‐weight-‐

loss.html 2 http://www.learning3pointzero.com/2011/12/09/all-‐learning-‐is-‐social-‐learning/


Different Markets, Different Objectives, Different Devices Every day, it seems, another device is

introduced that measures and tracks physiological ‘vital signs.’ Rapid technological advancements are making it possible to purchase and comfortably wear biosensor equipment that previously was expensive and unwieldy. These devices take many forms and address many different needs:

Doctors and nurses today can tote

portable ultrasound devices, such as the MobiUS SP1 Ultrasound System3, that are powered by a smartphone. Medical patients with high blood pressure can use the Withings Blood Pressure Monitor4; it connects to any iOS device. Results can be emailed to a doctor. The soon-‐to-‐be available Dario glucose meter5 also connects to a smartphone; it will likewise allow diabetics to record and share measurements. The Withings and Dario are available for consumers, also.

One company, Zephyr Technology in Annapolis, Maryland, supplies monitoring devices

for use by soldiers, athletes, medical patients, and consumers. Their Physiological Status Monitoring system is already being used by Special Forces, NASA, Navy Seals, and by first responders around the country. Live data is streamed from sensors embedded in undergarments made by UnderArmour, providing “real-‐time insight into the potential of heat stress, fatigue and dehydration.” College and professional sports teams, including the University of North Carolina men’s basketball team, the Phoenix Suns, Cleveland Browns, and others, are using this system for training.6 For medical patients, the BioPatch, a small wireless transmitter, allows for central monitoring of an entire hospital ward as well as remote monitoring of patients outside the hospital. Zephyr also sells consumer ‘activity trackers, including the HxM Smart.

3 http://venturebeat.com/2011/10/11/new-‐smartphone-‐ultrasound-‐device-‐is-‐finally-‐available/ 4 http://www.withings.com/en/bloodpressuremonitor 5 http://www.diabetesmine.com/2013/03/the-‐dario-‐turns-‐your-‐smartphone-‐into-‐a-‐meter.html 6 http://zephy-‐technology.com


Changes in brain activity during meditation by accomplished Buddhist monks have been charted in laboratories using fMRI imaging. In the search for brain activity substrates for mindfulness and compassion, the study concluded “…compassion meditation is accompanied by activation in brain areas involved with empathy as well as with happy and pleasant feelings, i.e. the left medial prefrontal cortex and the anterior cingulate gyrus.7” For us meditators not fortunate enough to take part in such research, the soon-‐to-‐be available Muse headband8 connects to a smartphone and will allow EEG brainwave monitoring for about $200. Wild Divine,9 another meditation aid available for consumers, measures GSR (Galvanic Skin Response, aka Skin Conductance Level) and HRV (Heart Rate Variability); it guides learners to manipulate these vital signs in order to control a computer game and win rewards. Heart Rate Variability measurements are also featured in several devices from the HeartMath Institute, including the Inner Balance10. These devices train the user to create optimal HRV by synchronizing breathing cycles with the heartbeat in a specific pattern, and by consciously generating positive emotions such as gratitude, appreciation or love.

7 http://www.cmiv.liu.se/research/current-‐research-‐projects/fmri-‐meditation 8 http://www.indiegogo.com/projects/muse-‐the-‐brain-‐sensing-‐headband-‐that-‐lets-‐you-‐control-‐

things-‐with-‐your-‐mind 9 http://www.wilddivine.com/science-‐behind-‐wild-‐divine/ 10 http://www.heartmath.com


Consumer “Activity Trackers” Through a kind of trickle-‐down process, these special-‐application devices have arrived at

the general-‐population consumer market, where demand seems fueled by the increasing number of people attempting to lose weight and improve general fitness. The following table compares what some different devices measure.

Form Factor/Design, User Interface/User Experience Design, and Social Media

There are several distinctive challenges in the consumer market. One challenge is to

design a device that is comfortable and either attractive or invisible. Several form-‐factors address this requirement: armbands (BodyMedia Advantage), small clip-‐ons (FitBit One), wristbands (Jawbone Up), watches (Basis Band), and earbuds (iRiver On). Another challenge is to create a user interface that is intuitive so that using the device requires minimal effort and attention and quickly becomes ‘second nature.’ Much design effort has gone into satisfying this requirement. The FitBit One takes the interface one step further with its onscreen coaching prompts. The final challenge, of especial relevance to my research, is that of engaging and encouraging the user, through social media, to persist in her/his efforts to achieve personal goals. To limit the scope of this paper, I have chosen to focus on weight loss efforts.

DEVICE steps intensity miles calories sleep pulse R5R stress HRV temp GSR EEG

BodyMedia)Advantage 1 1 1 1 1*

BodyBugg)SP 1 1 1

Nike)FuelBand 1 1 1

Jawbone)Up 1 1

Basis)Band 1 1 1 1 1 1

Amiigo 1 1 1

Ki 1 1 1 1 1*

ExerSpy 1 1 1

larklife 1 1 1 1 1

FitBit)One 1 1 1

Zephyr)HxM)Smart 1 1 1 1 1 1

HeartMath)emWave2 1

Wild)Divine 1 1 1

Muse 1

MEASURES


FitBit One: Personal Trainer Replacement? The remainder of this discussion will focus on the interface and social media of the FitBit

One. Among the devices I have researched (and tried), FitBit seems to have some best practices in place, practices specifically relevant to effectively motivating adults in their weight loss efforts.

What is measured:

• Steps • Distance • Calories burned • Floors climbed • Recent Activity (Flower grows and shrinks based

on your recent activity) • Sleep (total sleep, time in deep vs. light sleep,

how many times you wake during the night) Form Factor and Design The FitBit One is very small and therefore discreet: “Clip the Fitbit anywhere on your

clothes, or remove the casing and slip it right inside your pocket, handbag, or bra, as it will track your activity just about anywhere you place it. I wore our Fitbit One review unit for about a week, on various dresses, pants, and workout clothes, and never saw it budge.11

User Interface/Experience Design The designers seem to have modeled some interactive features

after the popular Japanese Tamagotchi12 electronic pet. This little device talks to you. If you leave the Fitbit One unattended it will present an inspirational message on its display, which you can customize using the desktop app13. If you are idle for too many minutes, it will prod you into action with encouraging messages such as "Walk me," "Vamos," or "High 5!"

“Another little neat detail is the Flower feature (pictured). Reminiscent of a Tamagotchi, the flower's height changes with the amount of activity it senses. If you are sedentary for a while, the flower will shrink. We found it to be a very helpful reminder of how long we had been sitting at our desks.14” Another user writes “if you're active enough, a pixilated flower will grow on the display. Maybe it's because the algorithm that causes the flower to grow isn't exactly clear, but

11 Jill Duffy, http://www.pcmag.com/article2/0,2817,2411271,00.asp 12 A Tamagotchi is a keychain-‐sized virtual pet simulation game 13 http://www.laptopmag.com/review/sportsaccessories/fitbit_ultra_wireless_tracker.aspx 14 http://www.laptopmag.com/review/sportsaccessories/fitbit_ultra_wireless_tracker.aspx


adding leaves to the stem is gratifying in a way that a dry number like steps or calories isn't; I'd ignore milestones like 5,000 steps, but obsess about getting that 10th leaf.15”

Especially for those serious about losing weight, FitBit sells a companion bathroom scale that syncs with the One. The Aria measures your weight, BMI, and percentage of body fat, and pushes that data to your Fitbit account in the cloud. The service even nudges you to drink water each day, with a default recommended amount of 48 ounces.16

The One syncs to a computer, smartphone or tablet, and displays all this data in easy to understand graphs. These stats are added to your personal history to show trends over the week or month. You can also manually log food, water, workouts, weight, and more using Fitbit’s online tools. “Our expansive database covers food and activities, which makes logging your info quick and easy. Create a Food Plan to eat smarter. Log an infinite number of activities, from walking the dog to swimming laps17.” FitBit also allows you to sync your data with several popular fitness apps. Some of them – including SparkPeople, Lose It!, MyFitnessPal, and MapMyFITNESS – let you import their data into Fitbit’s dashboard, so you can track and understand your health in either app18.

Social Media Where FitBit stands out

against the competition lies in the array of social media tools and resources they make available via a web browser. These resources and social activities provide positive reinforcement and encourage the user to move from a peripheral user stance towards a more involved, perhaps even ‘core user’ relationship with a community of like-‐minded adults. The company seems to understand the value of this social engagement for adults attempting to lose weight.

Notable among the user forums is one specifically for “Big Losers”– those seeking to lose more than 75 pounds. There are 594 members on the “New to fitbit , looking for other women over 50 working on weight loss” thread alone. This post epitomizes the social support that so many seem to find on FitBit’s online community: “I'm glad to know I'm not alone. I resonate with most all posts here. Im 54 and food is comfort to me (especially chocolate). Some days menopause really hits me and I reach for chocolate. I gained

15 http://www.wired.com/reviews/2012/04/reviews_bodymonitors/?pid=2286 16 http://reviews.cnet.com/personal-‐care/fitbit-‐zip/4505-‐14095_7-‐35451761-‐2.html 17 http://www.fitbit.com/one 18 ibid


15 pounds in the last 8 months. New job, brothers house burned down, parents moved, teenage son, etc... I have a total of 40 to lose but want to break it up into 5% segments to create small victories for myself. This forum is inspiring. Though I also want to add accountability. My husband doesn't work as a partner. He's thin and all this doesn't resonate with him. I joined My Fitness Pal to seek a fitness buddy with like goals and similar age and issues. Haven't created a relationship with anyone yet. Is anyone else on MFP?19”

The “1$ per mile” group leverages the ultimate motivator for meeting exercise goals: “Push further to get something special for yourself. Get a jar and put a $1 in it for every mile you walk that week or month. Enjoy buying your smaller clothing, or a special treat just for you with your reward money. Lets motivate and shop together!20”

Badges: Perhaps the most effective of all these strategies is the Badge. Badges are awarded whenever you surpass a benchmark, such as 5,000, 10,000, 25,000 steps and for 100, 250, or 3,000 miles. When I surpassed 10,000 steps in one day I received a “badge” acknowledging the accomplishment. It was an event worth celebrating. Apparently these Badges are a very potent motivator for many users:

“I do love earning my badges. Is there a list somewhere of the badges that we can earn? I just earned my 250 mile badge and want to know what the next is. I also have my 30,000 steps badge, what is after that?21” “Gaining one’s first badges, such as 5,000 or 10,000 steps, or 10 flights of stairs traversed, is pretty straight forward. But I wanted more. When I got home and put the kids to bed, I was at a mere 14 flights of stairs, so I literally, alone in a quiet house, went up and down my 15 stairs at home 11 times, to get to 25 flights. It must have been quite the sight. That got me a 25 flights badge, and later, when I interrupted each chore with 5 more flights, I finally made it to 50 flights of stairs, which earned me a new badge, not to mention a little bit of sweat and some tightness in my calves, which said the exercise might actually have been working. Tricked again! …Had it not been for the allure of the 50 floors badge, there’s no question I wouldn’t have been hiking up and down in my house in some solitary unfulfilling challenge. Had it not been for the intrigue of comparing my daily steps accumulated against my friends, and seeing if I could walk more steps than the previous day, or sleep more efficiently one night versus the previous night, I wouldn’t be thinking about it at all. Once the scale arrives and threatens to send my weight to my own internal profile, I wonder if it too is going to impact how I eat, measure and commit to something that resembles good behavior.22

“Approaching my astronaut badge. How motivating these badges are! I was just thinking though, this will be my final badge for lifetime floors -‐ 28,000 -‐ yet, when I earn it -‐ no

19 http://www.fitbit.com/forums/topic/4RR93Q3GWWT97 20 http://www.fitbit.com/community 21 http://www.fitbit.com/forums/post/4KTZ2J9SLN2HK/badges 22 http://blog.fitbit.com/?p=576


one will be able to see all the badges I've earned. Takes a little of the excitement out of earning them… …Got my Astronaut badge yesterday. There are no more badges for lifetime climb. Today I am finding it difficult to get up and down those stairs -‐ because I know that my daily climb badges cannot be seen by anyone but myself. I wish there were an option available for us to choose to show our badge page to anyone. If I thought that someone would notice -‐ I think I would be more motivated to get those daily badges. Right now, no one sees. Some of the incentive is gone.23”

In “Customer community and co-‐creation: a case study,” the authors state: “Focus on the engagement of customers in organizational learning, innovation, and knowledge processes heralds the dawn of a new paradigm… marketing intelligence is embedded in dynamic co-‐creation processes that involve customers as partners rather than subjects…communities can be enlisted in the co-‐creation of experiences.”24 FitBit, like other successful companies selling activity trackers aimed at weight loss and general fitness, understand that their role is not simply to sell activity trackers. The purchase of the device is the beginning of the relationship with the customer, not the end. The company has become sponsor and host for an online learning community of like-‐minded adults. The company’s role has evolved into one of customer community leadership.

23 http://www.fitbit.com/forums/post/4KTZ2J9SS6KX8/badges 24 Jennifer Rowley, Beata Kupiec-‐Teahan, Edward Leeming, Marketing Intelligence Planning

(2010) Volume: 25, Issue: 2, Publisher: Emerald Group Publishing Ltd., Pages: 136-‐146 (http://www.mendeley.com/catalog/customer-‐community-‐co-‐creation-‐case-‐study/#page-‐1)


Activity trackers, weight loss and the adult learner Weight loss seems to be one of the most common reasons for using activity trackers.

The large number of overweight adults who desire to lose weight and get fit is undoubtedly a primary target market for these devices. “Gallup recently found obesity rates now above 30% in several states and documented a continuing rise in the percentage of Americans diagnosed with diabetes, one of the most common health problems associated with obesity. Diet and exercise are the primary ways for Americans to lose weight and reduce the incidence of obesity in the U.S. Though many Americans express the desire to shed pounds, about half of those with that desire are following through at this time.25”

The typical adult consumer, in contrast to the patient, meditator, athlete, or soldier, is not working under the direct supervision of an expert–a doctor, a coach, or a superior officer. The social media that accompanies some of the most popular devices seems to be an attempt to create a surrogate for the expert, in the form of a digital personal trainer. In a clinical study at Northwestern University, obese patients who had a digital device (PDA) to track food and exercise, plus periodic check-‐ins with a coach, lost weight, while those who only recorded their food and activities on paper26 did not lose weight.

“The app is important because it helps people regulate their behavior, which is really hard to do,” said Bonnie Spring, lead investigator of the study and a professor of preventive medicine at Northwestern University Feinberg School of Medicine. “Most of us have no idea how many calories we consume and how much physical activity we get…The coaches’ most important role was … hovering and supportively holding them accountable. They know somebody is watching and caring and that’s what makes a difference…we need to engage them in tracking their own eating and activity, learn how that governs weight, and take advantage of social support.27”

It has been stated many times during “The Adult Learner” course that children and adult

learners are fundamentally different. Pedagogy, the ‘leading of children,’ is based on the assumption that “People are motivated to learn primarily by external pressures from parents, teachers/trainers, employers, the consequences of failure, grades, certificates, and so on.” Andragogy, the facilitating of adult learning is, on the other hand, based on the view that “The learner is self-‐directing... Adults are motivated to learn because of internal factors, such as self-‐esteem, recognition, better quality of life, greater self-‐confidence, the opportunity to self-‐actualize, and so forth. External factors, such as pressure from authority figures, salary increases, and the like, are less important.28

It seems to me that these differences have been exagerated. Like children, many adults need outside pressure to change unhealthy behavior. The major difference is that in weight-‐loss

25 http://www.gallup.com/poll/124448/In-‐U.S.-‐More-‐Lose-‐Weight-‐Than-‐Trying-‐To.aspx 26 http://archinte.jamanetwork.com/article.aspx?articleid=1485082#METHODS 27 http://www.northwestern.edu/newscenter/stories/2012/12/mobile-‐app-‐boosts-‐weight-‐

loss.html 28 Knowles, Holton, Swanson, p.183


competitions, like the Biggest Loser or the many versions of “gamified, public dieting apps29” (such as Drop10 or StickK), these adults are voluntarily signing up for outside pressure. “My fancy scale plus public shame should help me lose weight,” says a video game producer who currently weighs 18630. The only difference I see between these adult social activities and middle schoolers conforming to peer pressure is that these adults are choosing it. The basic mechanism of conditioned behavioral response to an external stimulus seems the same. To be fair, however, some proponents of Andragogy have pointed out that just because an adult chooses to ‘submit’ to a pedagogical learning situation does not mean he is not self-‐directing.31

Men, on the average, seem to prefer challenge, competition and shame as motivators. Some men share their weight via the Withings brand scales, which are programmed to automatically broadcast their average weight weekly on Twitter. “Withings WiFi Body Scale transmits your shame to the Internet …coming across its dispatches can feel like intruding upon a private ritual. But this technology is at the center of current weight loss innovation, which uses high-‐tech calorie counters, activity trackers, and social networks to make dieting more accurate and dieters more accountable32.”

Women, on the other hand, seem to prefer positive reinforcement. The activity trackers reviewed here all lean toward a kinder, gentler tactic of “encourage and engage.” As the website for the Basis Band puts it, “Social support also plays a big role. Most fitness trackers let you share your progress with public groups or create private groups to set collaborative or competitive goals, which is another great way to get support and encouragement from friends and family33.”

29 http://nymag.com/thecut/2013/04/created-‐by-‐men-‐women-‐now-‐public-‐dieting.html 30 ibid 31 Knowles, Holton, Swanson, The Adult Learner, p.186 32 http://nymag.com/thecut/2013/04/created-‐by-‐men-‐women-‐now-‐public-‐dieting.html 33 http://www.mybasis.com/en/basis-‐fitness-‐tracker/


Conclusion One of the core principles of Andragogical theory states “Adults tend to be more motivated toward learning that helps them solve problems in their lives or results in internal payoffs.34” Some adults lack the ability to self-‐direct or self-‐regulate their own behavior when it comes to eating and exercising, and thus find themselves overweight. Those who conclude that this is a problem that needs solving are thereby motivated to learn how to change these habits. While losing weight and gaining fitness are the obvious benefits of successful learning in this case, there is also social stigma against an adult who lacks self-‐discipline. It may be correlated with inability to control other behaviors, including those important in a new hire. In other words, being overweight may well cost you the job. “Perhaps no other aspect of andragogy has received so much attention and debate as the premise that adults are self-‐directed learners… There are two conceptions of self-‐directed learning prevalent in the literature (Brookfield, 1986, Candy, 1991). First, self-‐directed learning is seen as self-‐teaching, whereby learners are capable of taking control of the mechanics and techniques of teaching themselves in a particular subject….Second, self-‐directed learning is conceived of as personal autonomy…Autonomy means taking control of the goals and purposes of learning.35” I think it can be safely assumed that adults who resort to un-‐adult-‐like strategies in their pursuit of losing weight and gaining fitness (gamified public dieting, weight-‐loss challenges like the Biggest Loser, and other shame-‐inducing tactics like broadcasting your weight or your failure to get to the gym on Twitter) do so because they are unable to self-‐regulate these behaviors otherwise. So, they do what works. Some find motivation in challenge, competition, or even shame, while others find motivation in the comradeship of a weight-‐loss buddy or the emotional support of an online community. They are still self-‐directing in that they are directing the goals and purposes of learning. But unless the self-‐directedness is internalized, there may be a relapse once there are no more external goals and badges to achieve. The adult may be left to try once again to deal with the underlying impulses and to become self-‐directed in the sense of taking control of the mechanics and techniques of teaching themselves. In the ideal scenario, the adult gains new skills during the weight loss project that improve self-‐directedness and result in permanent change, regardless of what tactics are required initially,. This kind of learning pertains to adults far more than to children. Children, with less prior experience, have less need for unlearning. Prior experience can be a great resource in adult learning, especially in a group setting, but it can just as readily impede learning when new content is at odds with existing mental models, or schema36. Habits are automatic, endlessly

34 Knowles, Holton, Swanson, The Adult Learner, p. 199 35 ibid, p.185 36 ibid, p.190


repeating iterations of thought, speech, affect, and behavior produced by fixed schema. Habits are especially difficult to unlearn or learn for this very reason. Unlearning old habits and learning new habits is likely to involve what Chris Argyris calls double-‐loop learning: “Double-‐loop learning is learning that that does not fit the learner’s prior experiences or schema. Generally it requires learners to change their mental schema in a fundamental way.37” Even more pertinent to the subject of weight loss ‘learning’ is Donald Schon’s concept of reflection-‐in-‐action: “Reflection-‐in-‐action is the process of reflecting while performing to discover when existing schema are no longer appropriate, and changing those schema when appropriate. The most effective practitioners, and learners, are those who are good at reflection-‐in-‐action and double-‐loop learning.38” Single-‐loop learning is learning that fits prior experiences and existing values, which allow the learner to respond in an automatic way. Knowing-‐in-‐action is the somewhat automatic responses based on a persons existing mental schema that enable him or her to perform efficiently in daily actions.39 This kind of learning is relatively easy because it does not require internal change, but it also limits the possibilities for change to what is consistent with prior experience. Changing habits, whether of thought, feeling, attitude, or behavior, is not likely to occur without internal change. With single-‐loop learning and knowing-‐in-‐action, the result is simply more of the same, different only in detail. Habit change, such as permanent weight loss, smoking cessation, or quitting drugs, requires the more radical, transformative, change inferred in double-‐loop learning and reflection-‐in-‐action.

37 Knowles, Holton, Swanson, The Adult Learner, p. 190 38 ibid 39 ibid

Consumer Biosensor Devices: Technology, User Interface, and Social Media

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