RE: Five Strategies for Supporting Healthy Behavior Change

Summary

In this work, the researchers present five behavior change strategies that they claim are currently used in effective health self-management interventions. They also discuss how these strategies can be used in applications that support behavior change in the health/wellness domain.

Opinion

The one thing I find questionable about the strategies that were proposed in this paper is: can the designer set goals for the user? Naturally, one would have thought that prior to the use of any behaviour-change technology, that there is an interaction – a form of negotiation – going on between the user and the designer, with each side able to assert their own priorities and goals. Again the authors of this paper do not make the important distinction on whether the proposed strategies are better served for usability or persuasion.

Perhaps it’s better to aggregate all persuasive technologies as conceptually unique systems which require a generalized framework of design principles. Designers should try to avoid developing strategies that are tailored to specific genre into a specialised area like health; but instead build on the observation that this research deals with central aspects of what design is about. From such a position we may take on the challenge of how to develop design to more consciously deal with issues of persuasion based on proven social and psychological concepts. Not primarily because we want to persuade people, but because we need to understand the persuasive dimension of the dialogue between the designer, the technology and the user, and how this dialogue can be improved or manipulated.

Response: Five Strategies for Supporting Healthy Behavior Change

Summary:

In this paper, they examine techniques to support behavior change. The techniques they examine are gathered from a review of published research, books and interventions. Their primary focus in the review was focused on relationships between the behavior change strategies and success, in addition to potentials for broad application in the domain and in interactive systems. From their analysis, they found five strategies – short term and specific goals, actionable goals, confident goals, behavior triggers and self-understanding through experimentation. In their discussion, the researchers highlight how combining several of these goals, especially motivation can be challenging for system design.

Response:

To me, this paper was a representation of trying to translate real world health motivational “systems” to the digital domain. From my experience thus far, the best motivators are usually ones that are people. And from the findings in the paper, it suggests that this translation to a digital domain is difficult. In my opinion, systems shouldn’t necessarily REPLACE existing real world systems, but simply enhance it. In some gyms, for instance, they utilize software to enhance a specific workout regimen or training goals. It also lets the primary motivator perform self-experimentation. In all the cases they examined, a human facilitator improved the health system. This to me, represents that it is simply not possible to put a digital face on something so personal about your health.

Summary Response Week 11: Behavior Change & Personal Informatics

CPSC 601.25 Week 11 Part 2

Papers

In this response I will discuss a paper which reviews strategies for behaviour change from the medical literature and suggests some design guidelines for building 'behaviour change' applications.

Behaviour

Convincing patients to eat better, exercise more and take their medication has been a standing problem in medicine for years. Long term longitudinal studies on medications have to consider 'non-compliance' because completely rational people do not take their medicine. This is an interesting problem from the perspective of psychology but it's also a very practical problem for patients and doctors. Evidently in the medical field some evaluation has been done on 'interventions' to try to convince patients to change their behaviours. The researchers review some meta-analysis about this, as well as existing papers and books to extract strategies. They then consider how these strategies could be integrated in behaviour changing software.

The authors suggest 5 strategies, of which the first 3 relate specifically to so called 'action plans'. These action plans should be made up of goals which are short term (1) and actionable (2) - meaning that they are actions that people can take - and which the patient feels confident (3) in accomplishing. These are interesting, and consistent with other topics about self regulation, but seem sort of limited to an app whose job is to create these action plans. But it's possible that all behaviour changing apps will require this component. Another difficulty is how to programatically decide whether the proposed goals meet these conditions. One approach might be to offer specific and strict templates with sanity checks - allowing users to lose x number of pounds a week, etc. It's also difficult to asses what someone feels confident with, the authors suggest asking them on a scale of 1 to 10, but this is super lame. Another approach might be to target a goal that is below average and adjust it incrementally based on performance.

Constraints

The authors never give raw statistics on how effective these interventions generally are, but we can assume they are not very effective. If they were effective we would see less people dying of preventable choices that they've made, such as smoking, being overweight or sedentary, etc. From the field of psychology some concepts from self regulation could be coupled with these strategies. The Beeminder technology charges you money, if you deviate from your assigned quantifiable plan. Other apps try to add a social component to shame people who deviate from their stated goals.

Overall

This paper was surprisingly good for being a meta-analysis paper and being published in CHI. The paper presented clear design goals with examples and rarely descended into obscure and pointless language. It also seemed possible that they intended to develop software around these design goals and apply it to a real world problem.

Response to Video Playdate: Toward Free Play across Distance

Summary

In this paper the authors investigate how video conferencing can be used to help support children play together. They look at a variety of different conditions and how each affected the children's style and enjoyment of the play.

Reaction

Looking at particularly young children is interesting because they are less familiar with the concepts of video conferencing and what to do, but more adaptable and likely to take on a technology (see children with iPhones). Children are also less likely to put up with nonsense on the part of the technology or the conditions of the experiment. Free play is also a very interesting topic to tackle because unlike many of the studies we have looked at it is the kind of activity children actually do on a regular basis.

 Certainly the technology constrains how well this type of system will work at the moment. It would be interesting to see if a "same virtual room" condition (like Bon and David have worked on) would produce interesting results (or if it would simply produce situations like they saw with the rug).

Alternately rather than the mobil condition that the authors used, it would be interesting, possibly for slightly older children, to provide them with a robotic avatar. There was a research at an Ontario tech company (possibly RIM, I don't remember) who telecommuted, but had a robot with a screen and a camera at his office which he could use to replicate many day-to-day activities like going to someone's office to talk to them. This approach would give the remote partner more interactivity in the space (bi-directionality would probably be a problem), and it would be interesting to see how children respond to "their friend, but in a different body".

RE: Family Portals: Connecting Families Through a Multifamily Media Space

Summary

To explore the nature of familial interactions through video conferencing, this research designed a media space, called Family Portals, which was deployed to provide shared video that permitted sharing everyday life over extended periods of time between multiple locations – specifically in the homes of six families.

Discussion

It was interesting to see how multiple families could connect over distance, maintaining an awareness of one another and participating in shared activities, thus enhancing the familial connections they feel by seeing each other through the concept of media spaces. I would argue with the final results which indicated that media space increased feelings of connectedness between the triadic spaces, because it is hard to find an accurate measure of connectedness, or closeness, in shared human spaces. A key consideration would have been to measure the exact nature of the real-life or face-to-face relationships, albeit in dyadic or triadic connections, and to find ways to replicate this in the multi-media space. This could help in alleviating the privacy challenges which the researchers identified.

Response: Family Portals :- Connecting Families Through Multifamily Media Space

The researchers studied the use of a video conferencing (family portal) between three families--referred to as a triad. The family portal did not include audio for privacy reasons. However, a whiteboard was provided to communicate through hand written messages. The researches selected a triad that were close to each other and wanted more communication. Moreover, the connection between the families were women as reported in a study that women are household communicators. for e.g, One triad was between a mother, her daughter, and the daughter's sister.

Results of the Study:
In general the families enjoyed the opportunity to get more connected and shared more information than usual. In addition, they were able to connect with more than one family member.The researchers observed some family member--adopters that were not initially interested in extra communication, however started getting comfortable with the other families gradually. The intention of the portal was multi family communication, due to differences in schedules synchronous communication was low. However, the families left messages on the whiteboard to share with all. Families also used the whiteboard for playing.
Most families left the video on and did not have any privacy concerns. Four individuals did not like the use of the system, because it was intrusive, or from fear of technology, or they were not interested in additonal communication. To manage privacy, the family portal was turned facing a wall when not intended for communication rather then switching off.

Review:
I like the idea of the family portal, as i skype with my parents and sisters separately. I even like the use of the whiteboard, because you can leave messages there for everyone to see and know if something important is going on. Though this will not raise privacy issues with my family, but yes incase i use it with my in-laws. However, i wonder if you need a separate device for it, i wonder if it was computer application or part of facebook, what the results will be. I can see myself using it to communicate with a bunch of old friends, or cousins to discuss an upcoming wedding….

Summary Response Week 11: Free Play Over Distance

CPSC 601.25 Week 11 Part 1

Papers

In this response I will discuss one paper which considers a system for supporting 'free play' for children over video conference.

Free Play

Children develop normally when they interact and play with others in an unstructured and active way. The authors of the paper call this process "learning sociocultural and emotional competencies". In spite of this language, the concept of free play is open to anyone from their own childhood. The authors suggest that this time is being cut into by television, which is interesting as time spent watching television seems to be decreasing for most groups. Since this free play is probably important to normal development, such as a decline might have implications for children.

The researchers tackle this problem by trying to find out if free play can be conducted over video conferencing systems. Since video conferencing systems were designed to allow people at work to communicate with people who it was not possible to see face to face, probably because the costs of travel, we can assume some cost or force is stopping parents from (a) knowing and trusting other parents and (b) allowing their children to play with one another. The researcher suggest that maybe it would be possible to combine the benefits of free play for children with the convenience of leaving your kid in front of the TV for 12 hours a week.

Study

The researchers first conducted a pilot study using three pairs of kids with a pre-existing relationship, such as being friends or relatives. They used a pre-existing video conferencing system in a laptop and tv configuration. Being children they had difficulties understanding the technical problems associated with video conferencing such as visibility or audio problems. The boys preferred a large TV and the girls the laptop configuration.

The researchers then propose a more advanced set of conditions for testing distributed play, including higher fidelity video conference, pan and tilt cameras supporting by wizard of oz techniques and a 'shared rug' that children could play on. They recruited 26 pairs of friends to play together using the prototype system and coded the results of the interaction. The researchers do not carefully consider the impact of having the sessions done only once and in a laboratory setting.

They seemed to find that most of the problems with the system could just be resolved by increasing the fidelity of the video conferencing, as their 'vanilla option' seemed to be rated second only to face-to-face play. The projector rug, which appears somewhat dangerous from the picture, appeared to be confusing for some of the children, as it required distinguishing their own objects from the projected ones. The mobile condition was considered bad because children had to move and compose the view of their partner. It seems in general that visibility was a big difficulty because it requires a child to be aware of the (technology limited) visibility of another person.

Conclusion

Making children play over video conferencing seems like a strange idea. Years of effort by the HCI community and commercial products have not succeeded in make video conferencing a substitute for face to face meetings and in general remote work mediated by video conferencing is still difficult. It seems strange to expect that these problems would not be exacerbated by expecting children to use to the technology. The decline of free play for children is a serious social problem and attempting to solve it by technology like this seems silly and trivializing to the problem itself.

Response: Family Portals

Summary:

Communicating with family and close friends, who live far away, was the focus of this paper. The researchers examined methods in which close-knit families could interact with each other intimately and still be in their respective locations. The examination was done by their implementation “Family Portals”, which allowed for video conferencing, messaging and a shared whiteboard. While each of these features itself is not unique, framing it for a family environment was. This system was tested in 2 different “triads” or family groups for 8 weeks total, and they found several interesting results. The results seemed to indicate that a lot of real world communication patterns transferred to the digital domain. Solitude, for instance, was further enhanced in some cases, because seeing but not being able to communicate was frustrating for one of the mothers in the triad. Further, it also allowed users to be selective (just like in real life), by physically placing the system in their ideal locations, so that family could not always see what they were doing. Overall, the paper and its finding suggested that communication in a family (or close-knit) group requires a strong need for communication amongst all the parties and that if proper adoption is done, relationship dynamics can be enhanced or created. Generalizing these results to larger families however, would be a challenge, as stated towards the end of the paper.

Response:

This was an interesting paper to me, because of the focus on long-distance family communication. Many of the primary communicators in the system were young and able to adopt the system easily. I know in my case, for some overseas family members, adopting such technology would be extremely difficult, because it would not fit socially. The most interesting result for me, in this paper, was the changed relationships because of the system. They used the whiteboard more; they were more involved in each other’s lives and most likely felt closer. In this respect, the system was a success. On the flipside, the system also allowed for family members to be “more annoyed” with each other, by not answering the “knocks”, for example. In some respects, this is limited in real life because they do not see each other ALL the time, but a constant connection removes that. I would have liked to a longer study on the system and the change in relationship dynamics. Additionally, testing the system on budding relationships would be an interesting experiment, to see if relationships can form FROM the system itself.

Response: This is not a One-Horse Race

This paper is a study of a multi-player group based health game. The paper focused on the behaviour and motivation of individuals that can effect the participation of themselves and influence others in a group health game.
The researchers studied the American Horse Power game competition among 15 middle schools. The research did not focus on the effect of the physical activity on the individual's body, just the step count. The researchers interviewed 200 people including the participants and teachers from the school. This paper was able to identify 5 prominent categories of participants.

Achievers: They focus on game related goals and behaviours to achieve these goals. They concentrate on personal performance and are not competitive in nature. They are mostly are not athletic and set regular activities as goals (such as walking). Moreover, they fear social pressure and negative views of others on their activities therefore they do not influence  others by sharing their step count.
Active Buddies: These players have a small group of friends with whom they interact and enjoy activities on regular basis. Therefore, they can influence each other towards positive reinforcement. They enjoy a friendly competition among themselves.
Social Experience Seekers: These players are motivated more towards the sharing of their activities and profiles with friends and classmates. Since, with this system they could modify their avatars with no relation to their physical activity, they did not concentrate on their step count. However, we did see in the Ubigreen system that this can be used to motivate such players. They have the ability to influence others, because they promote themselves and their activities.
Team Players: These players are motivated by a sense of belonging to a team. They kept track of the schools progress with other schools. They shared their participation with the teachers and were very enthusiastic towards their goals.
Freeloaders: Freeloaders are people who participate just not to feel left out or get the secondary benefits from participating(e.g a t-shirt, free lunch). Therefore, they do not care about the physical activity or the schools performance. They have negative influence on the groups motivation.

The paper gave suggestions on how to influence the low participating players into more active participation. For example, for social experience seekers, if they could buy things for their avatars based on increase in step counts. Moreover, there should be preference setting for players to share step count information.



No real time communication between players and no real time feedback - only when to login to the website .

Response: This is Not a One-Horse Race

Summary:

The purpose of this paper, was to examine how individual people play games within the context of a large group. The game chosen was a health-based game that depended upon pervasive technologies and was targeted at youth in schools. After the completion of a large field-trial, they found five player types that existed when individuals played their game. These types (achievers, active buddies, social experience seekers, team players and freeloaders) highlighted the precocious nature of individual vs. group rewards and that the balance depends on the user/player.

Response:

To me, this paper was about designing games that balance (or in some cases, leverage) the “me. vs everyone else” aspect. Their findings suggested a wide range of behavior, with personal health being a motivating factor. It would have been interesting to see a different game played for the trial, which had a potentially more imbalanced “me vs. everyone else”, that could have involved toys or candy (for example). Would there have been such a wide range of behavior? Would the game even matter at all if the reward was the focus? In these questions, a larger question comes to mind as well, namely, does the gameplay, or the game itself truly matter, if the outcome surpasses it?

Re: Understanding Player Types in Multiplayer Pervasive Health Games for Youth

This paper describes the diversity of individual participation styles in multiplayer health games, based on an evaluation of a large-scale field trial of a pervasive technology-based health game for youth. Their findings highlight concerns and cares of youth participating in health games, and the impact of group-based competition on individual players. The research identified the five distinctive player types that emerged during interactions with this game: achievers, active buddies, social experience seekers, team players, and freeloaders. In addition to describing genres of players, they also present design suggestions for integrating group-based mechanisms effectively in health games for youth, among others.

Commentary

Games differ from utility software in some key characteristics: In games, the purpose is to have fun and enjoy playing the game. Learning to play the game, solving problems, or discovering new motivations is part of that experience. It is the prerogative of game designers to create the content and define goals that the players should strive to reach. Therefore, games have the potential to be intelligently adapted, as flexible media experiences, based on varying models and motivations of the players interacting with them. This adaptive approach to games has the potential to provide a powerfully individualized experience to game players, which, in turn, can achieved a targeted change in behaviour among users.

Summary Response Week 10: Games

CPSC 601.24 Week 10 Part 2

Papers

In this response I will discuss two papers, one which examines player types in health games and another which talks about variations in games.

Games

Games design is an interesting topic, a designer has to create a game that will challenge people while playing it keeping it interesting but not so challenging that it becomes frustrating. Some modern video games fully of glitzy graphics are essentially no different as games then early RPG shooters. Other simplistic games, such as Mario Brothers, are still fun to play even with a hokey style.

If game design is really about a set of rules (maybe a stretched definition) then we can think of variations to the rules as modifications to the design, like knocking down a wall is a modification to the design of a house. Consider a game like tic-tac-t0, a horrible game because it's entirely determined by the ordering of the players - provided that nobody plays the centre first. So rules of the game make it boring. Simply adding a new rule to the game might have a complex outcome that isn't obvious, the free-parking bonus in Monopoly, for example, makes the game last far longer because people are less likely to go bankrupt.

The researchers of the 'remix and play' paper create a taxonomy for rules by 'mining' a set of variants for poker. They then apply this taxonomy to rules for Halo2 variants. They find out that some rules are 'spoiling' and others 'satisfying'. But more interestingly they bring up how some variants - because of the limits of customizability of Halo2 - require that people voluntarily submit to the rules. Because the set of people playing has no social relationship, a huge set of enforcement and trust issues are brought up. This issues have been thoroughly studied in game theory and economics and psychology.

This paper is bad, not because the claims they make are not valid or their methodology is flawed, but because they have nothing to say. The research questions that we could ask and the studies that could be performed is effectively infinite. To be good the research must be interesting, but the conception of this paper is boring, nothing interesting could have even possibly come out of this research.

The second paper discusses the player types in multiplayer health games which are, unfortunately, a thing. The researchers review a specific example of such a system which was deployed at low-income schools in the United States. They found through interviews and quantitative analysis that each of the users could be categorized into a certain type based on their behavior. What was interesting is how affected some of the participants seemed to be by their relative status - or the idea that they would be shamed because they caused their team to lose. Without considering this a designer might have simply 'exposed' the steps every student in the system to try to encourage them. The freeloader problem seems like it could be solved by having 'real-world' intervention followed up by removal from the program.