Digital Health from an HCI Perspective - Contributions & challenges Geraldine Fitzpatrick Institute of Design and Assessment of Technology – HCI Group Vienna University of Technology (TU Wien) <geraldine.fitzpatrick @ tuwien.ac.at> @geri_fitz What Works in Digital Health Technologies – Bridging the Disciplinary DivideGlasgow. 23 July 2015 Image: https://commons.wikimedia.org/wiki/File:Merivale_Bridge_and_Go_Between_Bridge.JPG
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Digital Health From an HCI Perspective - Geraldine Fitzpatrick
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Digital Health from an HCI Perspective - Contributions & challenges
Geraldine Fitzpatrick
Institute of Design and Assessment of Technology – HCI Group Vienna University of Technology (TU Wien)
<geraldine.fitzpatrick @ tuwien.ac.at> @geri_fitz
What Works in Digital Health Technologies – Bridging the Disciplinary DivideGlasgow. 23 July 2015
Eg 100,000 health apps! [JMIR: mHealthApps: A Repository and Database of Mobile Health Apps - 2015]
Courtesy of Christina Mortberg, Uni of Oslo
At the computer In everyday life
User experience Designing ‘being human’
Usability Designing interfaces
HCI: changing scope of concerns
Inherently multi-inter
disciplinary
Google.com/glass
HCI & Self Care: A Literature Review [Years 1983 – 2013; 795 papers => 29 included in review]
§ HCI goals related to self care technologies: – Theoretical: understanding how technology can support – Practical: provide better tools for managing care
§ Design approaches – User centred and participatory design; – Ethnographically inspired design
§ HCI strengths: – Engaging with complex contexts and relationships
§ Multiple actors, settings, resources – Qualitative methods – Design-oriented studies to later small scale feasibility studies
Nunes, Verdezoto, Fitzpatrick, Kyng, Gronvall, Storni. Self-care Technologies in HCI: Trends, Tensions & Opportunities. To appear in TOCHI.
User Centred Design
Case:
Motivating Mobility Project
HCI, Physios SW engineers
Home visits & interviews
Therapy centre, stroke clubs
Physiotherapy treatments
Qualitative analysis Personas & storyboards
Prototypes & workshops
Co-design & in-home deployments 1 mth
Eval: Physio & HCI
Understanding Design Evaluation
What can HCI contribute to Digital Health?
Where are the disciplinary synergies/challenges?
Bridging for Digital Health
§ HCI can contribute strength in – ‘User’ perspectives, understanding everyday contexts, values, etc – Building ‘interesting’ usable applications – Understanding how/why tech used in real practices – Critiquing the ‘rational individual’ hidden assumptions
However…
§ Need to move to having real impact and value
– Evidence-based design decisions – in the ‘large’ and ‘small’ – Embracing all concerns & levels of scale – Embracing clinical outcomes as well as diversity of individual lived
Case: Parkinsons Disease [Francisco Nunes – study of Parkinsons UK forums]
“(...) I know that there are positives from taking DA’s
[Dopamine Agonist]. Physically I felt great whilst taking them, the mental damage [compulsive behaviours] however was
another story.
I had to make a choice...stay on the drugs and lose my family or come off them.
I put my family above my own ‘feel good factor’. (...)”
[glenchass]
Understanding how care is entangled with life Example: Impression management in different contexts
Aarhus et al, ECSCW2009; Nunes et al to appear TOCHI; O'Kane, et al. CHI2015. Diabetic Kit Photo courtesy of Stinne Aaløkke Ballegaard;
Understanding care & wellbeing as collaborative
[Balaam et al CHI2011; Fitzpatrick et al, WISH2011] [Sketch courtesy of Francisco Nunes]
HCI qualitative studies - insights
How people practically manage their H&WB and self-care
§ As situated negotiated practices – Deeply entangled in social, spatial, cultural, personal contexts – Negotiations & trade-offs between competing concerns, values etc
§ Ultimately not so much about clinical indicators but about living well
– Challenges ‘rational individual decision makers’ § Satisficing care to maximise quality of life
– Extends ‘unit of analysis’ from individual to ‘social practice(s)’
Moving to an ‘everyday practice’ perspective
Case: making healthy food choices / reducing food waste
‘Practices’ understaning
inspires different technology design approaches
From numbers/metrics, persuasion/change
to support for situated reflection / awareness
Ganglbauer, E. et al. 2013. From gardens to fridges: Negotiating food waste using a practice lens to inform design. In ACM TOCHI, 20:2 Reitberger, W., et al. (2014) Situated and Mobile Displays for Reflection on Shopping and Nutritional Choices. In Personal and Ubiquitous Computing, 18:7
FridgeCam
Nutriflect
[Drawing on Shove, Reckwitz and others]
§ Contribute strong qualitative user-centred methods – Understanding ‘everyday practices’, values etc – Understanding how/why people (might) use technologies
Work to do: § Engaging more with clinicians and other stakeholder
perspectives as part of research § Conducting research with cross-disciplinary methods/teams § Limited scalability § Communicating understandings
– Collating conceptual insights from meta analysis of case studies – Sensitising concepts, practices
Bridging for Digital Health
Designing …
User-centred & participatory design methods
Iterative prototyping based on feedback
Attention to usability, feasibility, user experience
eg eDiary – Diabetic pregnant women [Aarhus et al, 2009]
& many more …
Case: Diabetes
Many ‘HCI’ applications for health & well being
UBIFIT – promoting activity [Consolvo et al 2008]
Agile Life – active aging [Grosinger, Vetere, Fitzpatrick 2012]
Pass the ball [Rooksby, Most, Morrison, Chalmers2015]
Case: activity promotion
& many more …
Contribute § Good at user-centred designing / building ‘usable’
technology § Getting better at informing design from understanding
people and their contexts – useful technology
But what evidence base to support
§ The myriad small decisions that designers make? § What theories are relevant? § How to operationalise them in design?
Bridging for Digital Health
“…practitioners should be cautious when promoting the use of apps as it appears most
provide health-related information (predisposing) or make attempts at enabling
behavior, with almost none including all theoretical factors recommended for behavior
change.”
Role of theories of motivation / behaviour change for design?
§ What parts of the process or solution do theories relate to? Case: understanding motivation (Motivating Mobility) Theories Related concepts Category Related questions / statements Means of enquiry
Needs ERG Self determination X&Y Affective Arousal. Job des ign. Reinforcement . Social learning
Existence Relatedness Personally meaningful things Things avoided / attracted to Needs
Personal affect- 1. relatedness
Games I like to play..... Most important possessions..... The best bit of my day is....... The worst bit of my day is........ My favourite things …..
Top trumps game Clay impression Diary prompt Diary prompt Photo prompt
Smartphone apps for calculating insulin dose: a systematic assessment [Huckvale et al, BMC Medicine, May 2015]
§ Systematic issues affecting safety and reliability
“67% (n = 31/46) of apps carried a risk of inappropriate output dose recommendation that either violated basic clinical assumptions (48%, n = 22/46) or did not match a stated formula (14%, n = 3/21) or correctly update in response to changing user
inputs (37%, n = 17/46).”
The designer’s cop-out of the clinical disclaimer!
Contribute þ Good at user-centred designing / building technology
But … are they ‘good’ solutions?
Need § Interdisciplinary collaborations
– To navigate psychology/social science/health behaviour literature, to inform design choices
– To do better product design
§ Principled evidence-based guidelines – For the ‘small’ decisions as well as the big ‘theory’ ones
Bridging for Digital Health
http://www.usability.gov/
And much more … for later discussion e.g., Ethical, legal, challenges
Whose ideals, standards are we enforcing through design?
How are we conceptualising H&WB?
How do we code for privacy/control?
Who owns the data, who can access the data?
Free apps vs commercial agendas?
Evaluation
Qualitative Mixed methods
HCI & Self Care: A Literature Review [795 papers => 29. Years 1983 – 2013]
§ Evaluation Approaches
– Most studies explorative, design & experience oriented § Short term evaluations – small number of participants § Long term evaluations – weeks-months
§ Aimed at how people use the system and effect § Rarely assessed impacts on clinical outputs or physiological
measures
– Some RCTs, usually in collaboration with clinical partners
Nunes et al. Self-care Technologies in HCI: Trends, Tensions & Opportunities. To appear in TOCHI.
Case: Motivating Mobility
Process & publication challenges • HCI: engagement, acceptance, use – proof of concept
[Frost et al, Ubicomp2013] http://www.monarca-project.eu [Images courtesy of Mads Frost]
How to allow for emergent needs, ongoing design in use?
§ Despite participatory design & pilots
Use changes understanding of needs Appropriation processes
[Frost et al: Ubicomp2013; JMIR 2015]
How to integrate diverse evaluation perspectives?
[eHome Project]
[from 3millionlives.co.uk - 2014; was WSD; now Technology Enabled Care Services ]
Critical sociology perspectives: Eg
Technology perspectives:
Clinical outcome perspectives:
HCI People/experience perspectives:
Aceros, Pols & Domenech (2014). Where is grandma? Home telecare, good aging & the domestication of later life. Technological Forecasting & Social Change. Sanders, et al. (2012) Exploring barriers to participation & adoption of telehealth and telecare within the Whole System Demonstrator trial: a qualitative study. BMC.Health Serv.Res. Mort, Roberts, &Callen. (2012) Ageing with telecare: care or coercion in austerity? Sociol.Health Illn.
Organisational change perspectives:
The outcomes important to
patient’s?
How to explain diverse responses, choices, experiences?
The performative work of self care: Pressure of increased personal responsibility for health and
§ Calls from both HCI and clinical areas for new evaluation: – Field studies of appropriation over the long term
§ For all stakeholders – broad ‘unit of analysis’ – Realist evaluation [Pawson & Tilley 1997] conditions, contexts, processes by
which outcomes achieved or not
§ Relating appropriation processes & outcomes – Modified realist evaluation approaches – Help lead to design & practice guidelines
§ HCI contribute sensor/mobile technologies to understand – contextual/behavioural data and variations to help explain differences
in outcomes
Bridging for Digital Health
In conclusion
Bridging for Digital Health
§ HCI strong in – ‘User’ perspectives, understanding everyday contexts, values, etc – Building ‘interesting’ usable applications – Understanding how/why tech used in real practices – Critiquing the hidden assumptions of the ‘rational individual’
However…
§ Need to move to having real impact and value
– Evidence-based design decisions – in the ‘large’ and ‘small’ – Embracing all concerns & levels of scale – Embracing both clinical outcomes & diversity of individual lived
experiences
Calls for disciplinary bridges & collaborations!
Bridging Disciplinary tensions
§ Research approaches – Paradigmatic assumptions – Funding models – Timeframes – Numbers of participants – What is a ‘trial/study’