1 Conclusion
I started with a vision of Health-Zero and towards the goal proposed a
possible model to understand the influence of technology on
individual healthcare. The model was used to design and evaluate my
two explorations in the discipline. Each exploration was unique in its
own way and made its contribution to the understanding of HealthZero. The contribution of the thesis is at two levels:ji the design of
health technology and the individual explorations. I present the
contributions of the individual explorations followed by the
contribution to the field.
Exploration A
I developed a 3-lead wireless ECG sensor that can serve as a
building block for creating a distributed sensor network of wireless
bandage-sized sensors. The sensor used 2.4GHz communication
frequency. It supported bi-directional communication and could
connect with 125 other sensors at the same time. The system was built
with economies of scale and the prototype cost of the sensor was only
$48.
Exploration B
I developed a new computer-based ambient blood glucose level
visualization and feedback device and evaluated its effect on diabetes
self-care. Here feedback relates to the communication of the blood
glucose level to a friend or family member. The device was first of its
kind to display blood glucose level of an individual as a color and to be
able to automatically provide the same color value to a friend or family
member of the person with diabetes. It could wirelessly connect to a
glucose meter using bluetooth and upload the latest readings.
The evaluation of the system demonstrated the value of having better
mechanisms for visualization and communication of the blood glucose
levels of diabetes and the strong affective nature of blood glucose
levels. It demonstrated that designing better blood glucose level
visualization systems can help people better manage their diabetes
and can act as useful reminder of the blood glucose levels. It can also
help friends and family members of the person with diabetes to better
understand the blood glucose levels of the person with diabetes. The
study also demonstrated that such a system could potentially be useful
in increasing diabetes self-care of the person with diabetes and social
support provided by his social network in helping him manage his
diabetes. It also highlighted the strong psychological component of
self-care in diabetes that needs to be considered while designing
devices for the visualization of blood glucose levels.
The study was conducted with eight participants who were provided
with a Health-Zero orb that could display their blood glucose levels as
a color. Three of the eight participants gave a second Health-Zero orb
to a friend or family member. The participants were measured for
their self-care behavior at baseline and at follow up (end of 15 days of
use of the Health-Zero orb) using the self-care inventory. They were
asked to evaluate their use of the Health-Zero orb. There was a
marginal increase in the self-care behavior of six of the eight
participants. The participants also related individual experiences of
the usefulness of the Health-Zero orb in reminding them of their
blood glucose levels and in helping their friends and family members
to understand their blood glucose levels. The visualization of blood
glucose levels as a color was reported as less stressful than using a
number for the representation of the blood glucose level. As a strong
behavior measure for the evaluation of the system, all the participants
liked using the Health-Zero orb and felt it was fun to use. They also
wanted to use the system again provided the portability of the system
was improved. This study has shown that effective use of technology
to design devices for diabetes can have an impact on the self-care
behavior of people with diabetes and potentially increase the support
provided by their friend or family members in helping them manage
their diabetes. Another contribution was that it brought a feeling of
fun in observing the blood glucose levels, not just for the participants
but also their friends or family members.
Health-Zero
During the two explorations, few fundamental properties emerged of
Health-Zero. At times, a property itself was the guiding force in the
exploration and created the experience for an individual. At other
times, the absence completely changed the interaction and highlighted
their importance. The properties themselves have been stated at times
in design books but it is important they also form an integral part of
Health-Zero. They do not form a comprehensive theory for HealthZero but mark a beginning. I present them briefly here in the context
of the thesis. The reader is encouraged to back to the individual
explorations for details.
1.1.1 Experience vs. Utility
The joy of interaction with a system can overshadow its limited utility.
In contrast, the utility of the device can be overshadowed by the
frustration of the interaction. It is essential that that the design should
consider the experience of the individual with the system and not just
its functional need.
In the first exploration, this was demonstrated by the researcher
himself. The ECG sensor board was useful in its ability to record an
ECG signal continuously but the invasiveness of the electrodes
prevented it being used for the purpose. It was confined strictly to the
lab.
The use of the Health-Zero system by the study participants reemphasized this. The participants liked using the system but were
frustrated at times by its lack of responsiveness and mobility.
1.1.2 Personalization vs. Uniformity
Every individual has his own unique interaction with technology
based on the context of the interaction and his own state. One cannot
assume uniformity of experience through a design that assumes every
individual has the same need. The use of the Health-Zero system
highlighted the uniqueness of the experience and how the same
system can be of value to individuals in completely different ways. The
design basis of having uniformity of design and use of the system was
also challenged. Design of health technology needs to be personalized
to an individual to the extent possible. The aim is to help an individual
maintain his health – his unique state of well-being. <Design towards
the unique individual>.
It is a simple statement but very few designs follow it. Ask anyone
about their favorite color and they would be happy to tell you. And yet
health devices are devoid of color in a way that is similar to the earlier
hospital environments being strictly white and of a uniform color. Yet
the importance of blue vs green was demonstrated by a participant
who had blue as her favorite color.
1.1.3 Connectedness vs. Isolation
An individual cannot live in isolation and needs to interact with his
environment to maintain his health: his inter-personal relations and
the devices around him. If a health technology has to be effective in its
function, it needs to interact with these devices and inter-personal
relations. The bandage-sized wireless ECG sensor was designed to
connect to other networks. Participants who have the second HealthZero orb to a friend or family member related experiences of them
using the Health-Zero orb to provide support towards self-care
behavior. An individual is more than just his individual consciousness,
he is also part of a collective consciousness. <Design should be
towards the socially connected individual – not an island>
Earlier design could not follow the philosophy as the technology had
present. But with the presence of cheap transceiver, it is definitely
easy as demonstrated in the design of the ECG sensor
1.1.4 Continuity vs Discreteness
An individual is localized in time and space but his health is based on
a continous stream of interaction rather than a discrete point. A health
technology needs to be capable of sampling the state of the individual
with enough frequency to be able to determine the correct pattern of
change in the health of an individual. This is not possible by
intermittent measurement. One of the advantages of the ECG sensor
was its capability for continuous measurement. The mobility was
ensured because of its wearability. Its aim was to be able to measure
medically diagnostic information of which it fell short. A major
complain of the participants who used the Health-Zero orb was that it
was not portable enough to be taken with them. It was restricted to a
single place while the participants wanted it to be available to them
continuously.
The miniaturization of technology has made it possible for systems to
be small and light weight that user comfort can be balanced with the
functional specification of the system
1.1.5 Instantaneous vs Delayed
The state of an individual changes with respect to time and so does
information that corresponds to a state. For health technology to be
effective in providing information to an individual, it needs to ensure
that the information is valid for the current state of the individual. A
major problem of the Health-Zero orb was the delay in the change of
the color of the orb. The value of the color was lot to a large degree as
the blood glucose level was no longer current. Design towards
instantaneous information.
The rapid rise in the computation power available on a chip has
ensured that processing does not mean delays: at least for basic
algorithms.
1.1.6 Simplicity vs Complexity
Technology itself creates complexity and it can be used to encapsulate
the complexity to create simpler interfaces that are intuitive, if the
interfaces are required. The complexity of the interfaces of the HealthZero was a major problem.
1.1.7 Autonomy vs Dependence
Autonomy is essential for health technology to be effective in using its
connectedness to change the environment so it can help in the
maintenance of individual health.
1.1.8 Symmetry vs Asymmetry
The interaction between the individual and its
environment needs to be symmetric with respect to the
information flow. Both of them need to be made aware
of each other’s presence and state. The ECG sensor
made the environment more aware of an individual’s
state while the Health-Zero orb used the environment
to make an individual more aware of his own state.
Both the directions of flow are important for
interaction else it becomes difficult to control.
1.1.9 Information vs Data
Data from a health technology are important to individuals if only it is
presented and abstracted to a level of granularity that is useful to an
individual. The Health Zero was more useful to a friend or family
member as it displayed the blood glucose levels in a way it could be
understood by them: green means ‘ok’ and red means ‘high’.