By Dr. Conor Linehan, University College Cork
I had the great pleasure of attending two conferences this week, both organised by the Health Psychology group at NUI Galway. The first conference, on Monday 8th June, was a celebration of 21 years of the MSc Health Psychology at NUIG, and provided a fantastic overview of contemporary issues in theory and practice of Health Psychology in Ireland. The second conference focused on mHealth – or the use of mobile technology in support of health and medicine. The design of technology to support health and wellbeing is one of my own research interests, so I thought I would summarise and share the valuable lessons I learned from my attendance at the mHealth conference.
Firstly, an introduction. My name is Dr Conor Linehan. I am a newly-appointed lecturer in the School of Applied Psychology in UCC, and a member of the People and Technology (PAT) Research Group. The PAT group is a collection of human-computer interaction (HCI) researchers interested in understanding, designing, and evaluating digital technologies that aim to enhance people’s experience. We are particularly interested in understanding and developing approaches and methods that enable people to participate in designing their own futures. Previously, I was employed as a lecturer in Computer Science at the University of Lincoln, UK, and remain a member of the Lincoln Social Computing Research Centre, an HCI-led interdisciplinary research centre.
From my perspective as a HCI researcher who works on the design and evaluation of technology for supporting health and wellbeing, there were many new and interesting ideas presented throughout the event. However, there was one idea that stood out to me as particularly useful in considering the design of mHealth technologies; the idea that the real value of technology in promoting long-term behavior change is not in monitoring and motivation, but in serving as a catalyst for people to contact and experience the types of social groups and bonds that can sustain longer term behavior change.
Technology as Catalyst for Behaviour Change
The mHealth event was opened by a keynote from Dr. Liam Glynn of NUIG, who is also a practicing GP in rural Co. Clare. Glynn described a randomized control trial called SMART-MOVE in which the authors examined the effectiveness of a mobile phone application for increasing physical activity. Participants wore pedometers to measure their daily step count and were either encouraged to increase their daily step count by their physician, or prescribed the use of a smartphone app that would help them track and visualize their step counts. The group who used the app recorded significantly higher step counts per day than a control group. Feedback and goal setting provided by the application appears to have successfully motivated participants to increase their daily physical activity levels.
The SMART MOVE study, like most technology evaluations, was a short-term (8 week) study. There are often concerns expressed over the long-term effectiveness of persuasive design strategies based around the type of extrinsic motivation seen in the SMART MOVE study . In other words, many studies have found that apps that quantify, visualise, and offer positive reinforcement for behavior change can often lead to initial changes in behavior. In that period, the participant is often highly engaged with the application, attending to it regularly. However, there are concerns over what happens when the novelty of the application wears off, or when participants habituate to the simple rewards offered by the application. If the participant stops using the application, do the positive effects that it had on their behavior disappear? This is a concern, since the benefits of physical activity interventions on physical health only accrue through long-term change.
The exciting part of the SMART MOVE study, for me, was the qualitative evaluation carried out to understand participants’ experience of using the app. The qualitative study allowed researchers to understand social and contextual factors surrounding usage of the application. Interestingly, that qualitative study identified “a cascade effect in participants’ wider lifestyle behaviour and among their families and communities as a result of their use of the app.” Furthermore, not discussed in the paper, but in response to questions at the mHealth event, Glynn anecdotally described reports of participants joining and even setting up walking and running clubs in their local area. In other words, through using the application, participants in this study began to engage in the types of activities that are more likely to maintain longer-term changes in behaviour.
This study helps us to reconsider the types of outcomes we should measure as part of mHealth interventions, and the research methodologies appropriate for doing so. While quantitative measures of application usage or user engagement can give us information about initial uptake, measures of social networks and social support around the behavior of interest are probably better indicators of long-term behavior change. Of course, this is probably nothing new to health researchers, but it certainly is to those people who design, develop and evaluate the software!
A recurring theme throughout the two events I attended in Galway was the insistence that Health Psychologists have a key role to play in designing and evaluating health interventions. I couldn’t agree more with this statement. However, I also believe that Human Computer Interaction and Interaction Design researchers have much to contribute to the process of designing and evaluating mHealth technology.
HCI has recently become concerned with designing and evaluating experiences, rather than technologies. Technologies are considered as flexible tools used to support desired experiences. Those desirable experiences are ideally defined through collaborative participatory design methods carried out with interested stakeholders. Methods used for evaluating technology include usability studies, focus groups and interviews, but also ethno-methodologically inspired studies of technology use “in-the-wild.” Those studies aim to understand the effects of technology on the full and complex range of a persons lived experience, from the phenomenological, through the cognitive, behavioural and social.
If you are interested in learning more about research and practice in HCI I recommend that you read “Experience-centered design: designers, users, and communities in dialogue” by Peter Wright and John McCarthy, which provides a fantastic introduction. Prof. McCarthy, incidentally, is the head of School of Applied Psychology at UCC and director of the PAT research group.
If you have any questions or are interested in discussing HCI research and practice, please get in touch: firstname.lastname@example.org
You can also follow Conor on Twitter