Summer is over and Joy at Work is finally here. Well, at least that is the slogan for the Nordic Ergonomic Society’s yearly conference – NES 2017. This year it is three days of keynotes and presentation sessions in Lund, Sweden, at the Ingvar Kamprad Design Centre. As human-computer interaction ows some of its heritage to ergonomics, there are more than a few interesting presentations from our perspective. I notice that there are some presentations relating to eHealth which seem highly relevant to our DISA project, for instance.
On the whole, the conference sessions cover a lot of themes relating to ergonomics, its hard to identify any specific trends. On the contrary, I think the conference width is a good reminder of how complex working life actually is. Perhaps the inclusion of a special session for presentations relating to flexible workplaces is the strongest indicator of a hot new topics.
Monday ended with a tour of the lab facilities of the host, the division of Ergonomics and Aerosol Technology. This was a really pleasant surprise as the five stations in different labs revealed five very engaged researchers and some at times very hands on experiences of various equipment. I think a couple of the presenters could almost have persuaded me to change career. Science at its best.
Then there is also one presentation by myself on Tuesday afternoon, where I will discuss some of our experiences relating to the assessment of the Digital Work Environment in the wild. In a way, this presentation is just a teaser, as I will write more on this issue the coming months. For the very same reason I do hope I will get some input from the audience.
Yesterday, I handed my thesis manuscript over to the Uppsala University Library for the final prepress processing and subsequent printing of the thesis. After five and a half years of work, culminating in a quite intense spring and summer, this step marks the beginning of the very end of my PhD studies.
The thesis is titled ‘Inertia in Sociotechnical Systems: On IT-related Change Processes in Organisations’, and can be conveniently summarised using its abstract:
The introduction of new information technology (IT) in an organisation is one way of changing the conditions for how tasks and work processes can be designed and performed, as well as how people in the organisation interact with each other. Today, many Swedish workers rely completely on IT to be able to perform their jobs, while experiencing a combination of continuous and intermittent IT-related changes that affect this ability.
The introduction of new or updated IT systems in an organisation is an example of what is referred to as an IT-related change process in this thesis. Because IT has become such an integral part of modern organisations, many change processes in organisations are simultaneously enabled and constrained by the IT systems involved in a change process. In this thesis, I introduce the concept of inertia in sociotechnical systems to analyse IT-related change processes in organisations, and how achieving the goals of these processes is complicated by organisational, social, and physical aspects in addition to technology.
The context of this thesis is the Swedish public sector domains of health-care and higher education, and the result of research studies and experiences from four action research projects in these settings. The contribution of this thesis adds to the contributions of the included papers through the definition of inertia in sociotechnical systems and its subsequent application. The thesis shows that the concept of inertia in sociotechnical systems can be used to understand IT-related change processes as changes to the characteristics of a sociotechnical system, and, in the context of organisations, how these processes affect and are affected by an organisation’s characteristics. This is illustrated in the thesis through the application of the concept on examples of IT-related change processes from the included papers and research projects. In addition, the thesis shows that the use of vision seminar methods can benefit Swedish organisations, since new IT is often introduced without clearly defined, expressed, understood, and accepted goals.
The defense of the thesis (the Swedish custom of public final examination of a PhD student) will be held on Friday September 15th at 13.15, in room 2446 at the Polacksbacken campus of Uppsala University.
The comprehensive summary of this thesis-by-publication style thesis will be published online three weeks prior to the defense.
Like others from the HTO group, I also attended the first week of the eHealth summer school, which was sponsored by EIT Health and ACM SIGCHI, the special interest group of human-computer interaction (HCI). The first week of the summer school took place in Dublin and I think it was fantastic! It was so great to attend the interesting lectures and to meet all these brilliant people, with whom I share an interest in improving healthcare and health IT. The lectures gave us food for thought, which is reflected in the blog posts that have been written about them (see posts by Åsa Cajander, Diane Golay, Ida Löscher, Jonas Moll). Something that stuck with me were various attempts to support people to change.
Behaviour Change & Compliance
During the first days, behaviour change theory and behaviour change interventions were discussed on several occasions, e.g. how to change behaviour like smoking, exercising, medication adherence etc. In one of our group activities, we applied the COM-B, which is a framework for understanding behaviour and stands for capability, opportunity, and motivation. I was neither familiar with the behaviour change theory nor medical interventions that make use of this theory and found it interesting and thought-provoking. A quote that I heard somewhere before kept creeping in my head: “Everybody wants to change the world but nobody wants to change.”
In his presentation on Fiction in the Design Process, Conor Linehan (School of Applied Psychology at University College Cork, Ireland) showed us this wonderful video, which can be related to a behaviour change that is rather extrinsically than intrinsically motivated:
On Wednesday, ACM distinguished speaker Geraldine Fitzpatrick presented case studies in the context of real homes that exemplified the complexities designers face, e.g. that a neat prototype of a smart kitchen might look quite different than a real kitchen in a messy and complex world. She also talked about the importance to understand everyday routines, e.g. when it comes to medication management, people tend to put their medication in places where they have to take them (e.g. next to their bed; in the kitchen next to the coffee machine, …). She gave an excellent example of a person with Parkinson, who made a very conscious and informed decision not to take the prescribed medicine due to negative side effects that were so strong that he feared to lose his family. This patient probably would have been labelled “non-compliant”, however, his situation was more complex than that. In order to account for the complexity, Geraldine mentioned the concept of concordance as an alternative to compliance or adherence (see for example Chakrabarti (2014), The European Patient Forum (2015)). I can relate to this concept much more, especially considering blog posts like this by Carolyn Thomas, from whom I learned how strongly patients react to these concepts.
Social Practice Theory
In her second talk, Geraldine presented work by Blue et al (2016), who suggest the use of social theories of practices as an alternative to behaviour change theory to inform new ways of “conceptualizing and responding to some of the most pressing contemporary challenges in public health”. Geraldine gave an example where this was applied in relation to smoking cessation, which coincidentally was also the project topic that my group was working on through the week. Rather than looking at the characteristics of the individual smoker, in the use case Geraldine presented the focus was on the life course of smoking as a practice. It includes material and symbolic elements of which smoking comprises and how these may have changed over time, or to which other practices they are related (e.g. socializing, drinking, etc).
Something that struck me while working with my summer school team on our project was the premise: It is difficult to quit smoking. Having been a heavy smoker myself until I quit in 2005, this was something I also always believed myself. This changed when reading the book by Allen Carr which helped me to reframe the way I perceived smoking. As a smoker, I would have told you that I really liked smoking. Thus, every attempt to quit made me feel like I am missing out; everyone around me was “allowed” to smoke – only I wasn’t allowed (poor me!), because I (once again) had decided to try (!) to quit. When I saw others smoke, I envied them – and I felt very sorry for myself. This changed after reading the book. It made me realize that it’s not the case that I am not allowed to smoke, but I don’t have to smoke anymore. So instead of looking at smokers with envy, I empathized with them like “Look: they still have to smoke; I am free of this.” This reframing changed everything for me and indeed made quitting really easy. Instead of feeling sorry for myself, that I was missing out, I seriously felt liberated. The routines or practices I had as a smoker then changed. For instance, I used to enjoy smoking in my car (disgusting, I know! Well, I know now!), smoking when meeting friends, while drinking a glass of wine, etc. So in my previous attempts to quit smoking, I felt that something was missing, when I encountered these situations. However, after finishing the book, I experienced situations, which I realized to be much more enjoyable and stress-free as a non-smoker (e.g. going to the movies or visiting friends who don’t allow smoking at their home). Maybe I was more attentive to these positive new experiences. In addition, reading the book I did not only reframe „Smoking“ but also „Smoking Cessation“, because the author challenges conceptions that cessation is difficult and one would suffer from withdrawal symptoms.
During the week, our group worked on project related to an app that was supposed to help cardiac patients to quit smoking. However, our prospective user did not want to stop smoking in the first place – which can be related to above discussion “Who wants change and who wants to change?”. At one point, I raised the question whether this person maybe have tried several times before to quit, has failed, and thus perceives cessation as being difficult. So why bother trying, right? And – as chance would have it – the other day during my morning run I listened to one of my favorite podcasts and learned that there is an app a theory for that: Learned Helplessness. In this episode, David McRaney interviews Kym Bennett, who researches Learned Helplessness. Depending on ones individual attributional styles (or explanatory styles), a person looks at an experience (e.g. a failed math test) and explain this for example in terms of “the test was particularly difficult; I didn’t study enough” or “I am bad at maths and all tests will be as difficult”. The latter interpretation is related to a pessimistic attributional style, which involves people who explain causes of negatives events as stemming from internal (“I am bad as math”), stable (“I’ll always be bad at math”, “I’ll fail also the next test”) and global forces (“This is pervasive”; “It will effect other aspects of my life”). I won’t got into more detail (please listen to the episode and the follow up; they are really great!), but following the learned helplessness theory, if a person has a pessimistic attribution towards something, then s/he believes that there is not much s/he can do about it (i.e. s/he perceives herself/himself as being helpless or powerless). Thus it is quite understandable that this person is not very motivated to change.
Coming back to my example, I don’t perceive myself as having a negative attribute style in general. But in relation to smoking cessation, I for sure had a pessimistic attribution: I failed at quitting before; I’ll for sure fail again; it’s really hard to quit smoking; everybody struggles to do that; I cannot really do anything about it. What the book then probably did was, what was explained in the podcast episode as attribution retraining. Allen Carr called his (not uncontroversial) methodEasyway®, which already reframed what I thought about smoking cessation. Wait, what?? This is supposed to be easy?? The book helped me to reflect, to be more mindful and deliberate – as was also discussed in the episode to overcome learned helplessness. And I kept thinking: Maybe eHealth solutions should support this mindfulness and reflection to be helpful and effective in health interventions, where people struggle to change their behaviour, even though they want to?
Reflection on Behaviour Change
There was something about some of the behaviour change cases that bothered me, but I couldn’t really put my finger on it. I may have misinterpreted the cases, but at times I perceived the approach as rather paternalistic, which is something that goes against my personal values – and maybe even against the basic principles of human centred design or value sensitive design. I could much more relate to the social practice theory and the coaching / reflection model presented by Geraldine. However, today I got more food for thought when reading a blog post by Jelle van Dijk who responded to Diane’s reflection of the summer school. He wrote:
One thing that is not discussed however is that there are many humans on this planet. And most computers are in fact tools supporting humans quite well, only these humans are not what we call the “end-users”, who in turn may be very frustrated by that same system. In fact there are often multiple different “users” of computer systems and often it is no longer one person that is using the system but rather a whole organization or ‘society at large’.
and further he wrote:
So this is one complexity we may add to the question of how to design human-centered HCI: do we mean the individual user interacting with the system, or do we mean that complete computer systems should ‘fit’ to the needs of larger societal systems (which may sometimes lead to individual people complaining about having to fill out stupid forms online and so on) – or do we feel there’s a way in which we can make everybody happy.
Maybe this is the difference between the various approaches that I couldn’t see before. The approaches that I perceived rather paternalistic may serve rather the “society at large” (i.e. take your medication; stop smoking; exercise more; eat healthy… so that you don’t become a burden to the society) while the alternative approaches that use for example coaching and reflection help the individual to help themselves. In the end the goal of the individual might be in concordance with or contribute to the societal goals, but the underlying basics of the approaches are quite different. Why not aim for systems that help individuals to reflect on their behaviour, possibly help them change for the better (whatever that is…), and by that potentially contribute to the greater good? Or is it impossible to make everybody happy? 🙂
The EIT Health/SIGCHI eHealth summer school was last week in Dublin. A summer school is a great opportunity for PhD students and other researchers to learn more about a subject and to get connected to other people with a similar interest. This summer school was about HCI and eHealth, and therefore a whole bunch from us participated, more exactly Christiane, Diane, Jonas, Åsa and me! (or Åsa is one of the organizers). The summer school will continue with one more week in the end of August, and that time in Stockholm and Uppsala!
The Dublin week of the summer school was very well organized by Gavin Doherty from Trinity College Dublin. The participants were a good mix between innovators and eHealth researchers from different related disciplines such as HCI, Technology, Health Sciences and Psychology, and also patients participated! We got to hear many good talks during the week, and had hands on exercises and group work. The talks covered for example patient and public involvement, user centered design, how to use fiction in the design process, designing for behavior change, inclusive design, internet interventions, ethics in eHealth, and some very interesting case studies! Geraldine Fitzpatrick from TU Wien gave a lecture called “Putting eHealth in context” and mentioned that instead of designing “smart” systems, we should focus on systems that enable people to make their own decisions.
You can read more about the summer school in Jonas’ blog (day 1, 2, 3, 4, 5), in Åsa’s blog, and in Diane’s blog (here, and here)! The week in Dublin was great and now I am really looking forward to the second week of the summer school in Stockholm and Uppsala!
Last Monday, I held a seminar on “the ethical handling of field research data”. There are indeed many laws and regulations researchers need to follow when collecting, processing, publishing and preserving research data. In Sweden, the requirements related to good record keeping in public institutions are particularly high since the principle of public access to official documents applies. This is why I decided to prepare a seminar on this particular topic as my examination in the Research Ethics course I took last month at BMC.
Following Åsa’s recommendation, I decided to do an interaction-based seminar instead of holding a more “traditional” presentation. In my preparation, I determined the topics I was interested in and wanted to include in the seminar, and gathered information about each of them. In the PowerPoint presentation I created for the seminar, I then added a few slides per topic. During the seminar itself, I started off by explaining to my audience which topics I had worked on, and asked them what aspects they were interested in talking about, or whether they had any question related to the topics I had prepared. They mentioned the three following questions of interest:
Can I take my data with me when I leave the University? Whom do the data belong to, and what does that imply for informed consent?
Video recordings: what do I need to pay attention to when handling such data?
What if I have messed up (lost my data, not submitted an application for ethical review, did not ask participants for consent)?
I addressed each topic one after the other, first giving some input with the support of the relevant slides from my PowerPoint presentation, then asking the audience for additions, examples and possibly other related questions. The discussions that each topic / question gave rise to were animated and thought-provoking, and always led to the generation of more questions than what we had started with! In spite of this, it seems that, based on the feedback I received later from some of the participants, the opportunity to discuss and reflect over those different ethical aspects of research was appreciated.
As for myself, I really enjoyed giving the seminar, and feel like I have learned quite a few things on the subject – even if one of them is that the legal framework we work with is difficult to put into practice. One of the main challenges I see is that it is hard to determine when a certain condition is fulfilled in practice. For example, is a so-called “working document” an official document? When does a document become official? Unfortunately, the fact that the interpretation of the different laws and guidelines that apply varies from institution to institution certainly does not make things easier…
Wednesday last week, and as a beginning of the Swedish MedTech week 2017, was the inauguration of MedTech Science & Innovation which is a new medical research and innovation centre in Uppsala. The centre is a long term collaboration between the Uppsala University Hospital and Uppsala University.
The day started with a welcome from Fredrik Nikolajeff and Marika Edoff from MedTech Science & Innovation. It was a busy schedule with many good presentations. Magnus Larsson, the head of the Digital Development Unit at the Uppsala University Hospital, talked about the digitalization within healthcare. Anna Attefall from Innovation Akademiska talked about how they support innovations, and she stressed the importance of user tests!
Further the program included many short presentations from researchers working with a broad range of MedTech applications. One example is Robin Strand from CBA and the division of Visual Information and Interaction at the IT department at Uppsala University (same division as the HTO group) who presented their work with advanced image analysis as a support for surgery. I was last out among the research presentations and talked about how important it is that the MedTech systems are usable, and how we work with including the user perspective.
The event ended with industry presentations, with for example Carl Bennet from the Getinge Group who stressed the importance to measure other values than costs to stimulate new innovations for better healthcare.