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CHI Highlights: Persuasive Tech and Social Software for Health and Wellness

I want to take few minutes to highlight a few papers from CHI 2011, spread across a couple of posts. There was lots of good work at this conference. This post will focus on papers in the persuasive technology and social software for health and wellness space, which is the aspect of my work that I was thinking about most during this conference.

  • Fit4life: the design of a persuasive technology promoting healthy behavior and ideal weight
    Stephen Purpura, Victoria Schwanda, Kaiton Williams, William Stubler, Phoebe Sengers

    Fit4life is a hypothetical system that monitors users’ behavior using a variety of tactics in the Persuasive Systems Design model. After describing the system (in such a way that someone in the room commented made the audience “look horrified”), the authors transition to a reflection on persuasive technology research and design, and how such a design can “spiral out of control.” As someone working in this space, the authors hit on some of the aspects that leave me a bit unsettled: persuasion vs. coercion, individual good vs. societal good, whether people choose their own view points or are pushed to adopt those of the system designers, measurement and control vs. personal experiences and responsibility, and increased sensing and monitoring vs. privacy and surveillance and the potential to eliminate boundaries between front stage and back stage spaces. The authors also discuss how persuasive systems with very strong coaching features can reduce the opportunity for mindfulness and for their users to reflect on their own situation: people can simply follow the suggestions rather than weigh the input and decide among the options.

    This is a nice paper and a good starting point for lots of discussions. I’m a bit frustrated that it was presented in a different yet concurrent session as the session on persuasive technology for health. As such, it probably did not (immediately) reach the audience that would have led to the most interesting discussion about the paper. In many ways, it argued for a “think about what it is like to live with” rather than “pitch” approach to thinking about systems. I agree with a good bit of the potential tensions the authors highlight, but I think they are a bit harder on the persuasive tech community than appropriate: in general, persuasive tech folks are aware we are building systems intended to change behavior and that this is fraught with ethical considerations, while people outside of the community often do not think of their systems as persuasive or coercive, even when they are (again, I mean this in a Nudge, choice-environments sense. On the other hand, one presentation at Persuasive last year did begin with the statement “for the sake of this paper, set aside ethical concerns” (paraphrased), so clearly there is still room for improvement.

  • Designing for peer involvement in weight management
    Julie Maitland, Matthew Chalmers

    Based on interviews with nineteen individuals, the authors present an overview of approaches for how to involve peers in technology for weight management. These approaches fall into passive involvement (norms and comparisons) and five types of active involvement (table 1 in the paper): obstructive (“don’t do it”), inductive (“you should do it”), proactive (“do it with me”), supportive (“I’ll do it too”), and cooperative (“let’s do it together”). The last category includes competition, though there was some disagreement during the Q&A about whether that is the right alignment. The authors also find gender- and role- based differences in perceived usefulness of peer-based interventions, such as differences in attitudes about competition.

    Designers could use these types of engagement to think about what their application are supporting well or not so well. Here, I wish the authors had gone a bit further in linking the types of involvement to the technical mechanisms or features of applications and contexts, as I think that would be a better jumping off point for designers. For those thinking about how to design social support into online wellness interventions, I think this paper, combined with Skeels et al, “Catalyzing Social Support for Breast Cancer Patients”, CHI 2010 and our own paper from CSCW 2011 (“‘It’s not that I don’t have problems, I’m just not putting them on Facebook’: Challenges and Opportunities in Using Online Social Networks for Health”), offer a nice high-level overview of some of the challenges and opportunities for doing so.

  • Mining behavioral economics to design persuasive technology for healthy choices
    Min Kyung Lee, Sara Kiesler, Jodi Forlizzi

    A nice paper that evaluates different persuasive approaches for workplace snack selection. These include:

    • default choice: a robot showing all snack choices with equal convenience or the healthy one more visibly, or a website that showed all snack choices (in random order) or that paginated them, with healthy choices shown on the first page.
    • planning: asking people to order a snack for tomorrow rather than select at the time of consumption.
    • information strategy: showing calorie counts for each snack.

    As one would expect, default choice strategy was highly effective in increasing the number of people who chose the healthy snack (apples) rather than the unhealthy snack (cookies). The planning strategy was effective among people who had a healthy snacking lifestyle, while those who snacked unhealthily continued to choose cookies. Interestingly, the information strategy had no effect on healthy snackers and actually led healthy snackers to choose cookies more than they otherwise would have. The authors speculate that this is either because the healthy snackers overestimate the caloric value of cookies in the absence of information (and thus avoid them more), or because considering the healthy apple was sufficiently fulfilling even if they ultimately chose the cookie.

    Some questions the study leaves open are: would people behave they same if they had to pay for the snacks? what would happen in a longer term deployment? What would have happened if the cookies were made the default, particularly for otherwise healthy snackers?

  • Side effects and “gateway” tools: advocating a broader look at evaluating persuasive systems
    Victoria Schwanda, Steven Ibara, Lindsay Reynolds, Dan Cosley

    Interviews with 20 Wii Fit users revela side effects of this use: some stop using it because it did not work while others stop because they go on to other, preferred fitness activities (abandonment as success), a tension between whether the Fit is viewed as a game or exercise tool (people rarely view it as both), and negative emotional impacts (particularly frustrating when the system misinterpreted some data, such as weight gains). One suggestion the authors propose is that behavior change systems might start with activities that better resemble games but gradually transition users to activities with fewer game-like elements, and eventually wean users off of the system all together. In practice, I’m not sure how this would work, but I like this direction because it gets at one of my main critiques of gamification: take away the game and its incentives (which my distract from the real benefits of changing one’s behavior) and the behavior reverts quite quickly.

  • Means based adaptive persuasive systems
    Maurits Kaptein, Steven Duplinsky, Panos Markopoulos

    Lab experiment evaluating the effects of using multiple sources of advice (single expert or consensus of similar others) at the same time, disclosing that advice is intended to persuade, and allowing users to select their source of advice. (This is framed more generally as about persuasive systems, but I think the framing is too broad: it’s really a study about advice.) Results: people are more likely to follow advice when they choose the source, people are less likely to follow advice when they are told that it is intended to persuade, and when shown expert advice and consensus advice from similar others, subjects were less likely to follow the advice than when they were only shown expert advice — regardless of whether the expert and consensus advice concurred with each other. This last finding is surprising to me and to the authors, who suggest that it may be a consequence of the higher cognitive load of processing multiple sources of advice; I’d love to see further work on this.

  • Opportunities for computing technologies to support healthy sleep behaviors
    Eun Kyuong Choe, Sunny Consolvo, Nathaniel F. Watson, Julie A. Kientz

    Aggregation of literature review, interviews with sleep experts, a survey of 230 individuals, and 16 potential users to learn about opportunities and challenges for designing sleep technologies. The work leads to a design framework that considers the goal of the individual using the system, the system’s features, the source of the information supporting the design choices made, the technology used, and stakeholders involved, and the input mechanism. During the presentation, I found myself thinking a lot about two things: (1) the value of design frameworks and how to construct a useful one (I’m unsure of both) and (2) how this stacks up against Julie’s recent blog post that is somewhat more down on the opportunities of tech for health.

  • How to evaluate technologies for health behavior change in HCI research
    Predrag Klasnja, Sunny Consolvo, Wanda Pratt

    The authors argue that evaluating behavior change systems based solely on whether they changed the behavior is not sufficient, and often infusible. Instead, they argue, HCI should focus on whether systems or features effectively implement or support particular strategies, such as self-monitoring or conditioning, which can be measured in shorter term evaluations.

    I agree with much of this. I think that more useful HCI contributions in this area speak to which particular mechanisms or features worked, why and how they worked, and in what context one might expect them to work. Contributions that throw the kitchen sink of features at a problem and do not get into the details of how people reacted to the specific features and what they features accomplished may tell us that technology can help with a condition, but do not, in general, do a lot to inform the designers of other systems. I also agree that shorter-term evaluations are often able to show that particular feature is or is not working as intended, though longer term evaluations are appropriate to understand if it continues to work. I am also reminded of the gap between the HCI community and the sustainability community pointed out by Froehlich, Findlater, and Landay at CHI last year, and fear that deemphasizing efficacy studies and RCTs will limit the ability of the HCI community to speak to the health community. Someone is going to have to do the efficacy studies, and the HCI community may have to carry some of this weight in order for our work to be taken seriously elsewhere. Research can make a contribution without showing health improvements, but if we ignore the importance of efficacy studies, we imperil the relevance of our work to other communities.

  • Reflecting on pills and phone use: supporting awareness of functional abilities for older adults
    Matthew L. Lee, Anind K. Dey

    Four month deployment of a system for monitoring medication taking and phone use in the homes of two older adults. The participants sought out anomalies in the recorded data; when they found them, they generally trusted the system and focused on explaining why it might have happened, turning first to their memory of the event and then to going over their routines or other records such as calendars and diaries. I am curious if this trust would extend to a purchased product rather than one provided by the researchers (if so, this could be hazardous in an unreliable system); I could see arguments for it going each way.

    The authors found that these systems can help older remain aware of their functional abilities and helped them better make adaptations to those abilities. Similar to what researchers have recommended for fitness journals or sensors, the authors suggest that people be able to annotate or explain discrepancies in their data and be able to view it jointly. They also suggest highlighting anomalies and showing them with other available contextual information about that date or time.

  • Power ballads: deploying aversive energy feedback in social media
    Derek Foster, Conor Linehan, Shaun Lawson, Ben Kirman

    I generally agree with Sunny Consolvo: feedback and consequences in persuasive systems should generally range from neutral to positive, and have been reluctant (colleagues might even say “obstinate”) about including it in GoalPost or Steps. Julie Kientz’s work, however, finds that certain personalities think they would respond well to negative feedback. This work in progress tests negative (“aversive”) feedback: Facebook posts about songs and the statement that they were using lots of energy in a pilot with five participants. The participants seemed to respond okay to the posts — which are, in my opinion, pretty mild and not all that negative — and often commented on them. The authors interpret this as aversive feedback not leading to disengagement, but I think that’s a bit too strong of a claim to make on this data: participants, despite being unpaid but having been recruited to the study, likely felt some obligation to follow through to its end in a way that they would not for a commercially or publicly available system, and, with that feeling, may have commented out of a need to publicly explain or justify their usage as shown in the posts. The last point isn’t particularly problematic, as such reflection may be useful. Still, this WiP and the existence of tools like Blackmail Yourself (which *really* hits at the shame element) do suggest that there is more work needed on the efficacy of public, aversive feedback.

  • Descriptive analysis of physical activity conversations on Twitter
    Logan Kendall, Andrea Civan Hartzler, Predrag Klasnja, Wanda Pratt

    In my work, I’ve heard a lot of concern about posting health related status updates and about seeing similar status updates from others, but I haven’t taken a detailed look at the status updates that people are currently making, which this WiP makes a start on for physical activity posts on Twitter.By analyzing the results of queries for “weight lifting”, “Pilates”, and “elliptical”, the authors find posts that show evidence of exercise, plans for exercise, attitudes about exercise, requests for help, and advertisements. As the authors note, the limited search terms probably lead to a lot of selection bias, and I’d like to see more information about posts coming from automated sources (e.g., FitBit), as well as how people reply to the different genres of fitness tweets.

  • HappinessCounter: smile-encouraging appliance to increase positive mood
    Hitomi Tsujita, Jun Rekimoto

    Fun yet concerning alt.chi work on pushing people to smile in order to increase positive mood. With features such as requiring a smile to open the refrigerator, positive feedback (lights, music) in exchange for smiles, automatic sharing of photos of facial expressions with friends or family members, automatic posting of whether or not someone is smiling enough, this paper hits many of the points about which the Fit4life authors raise concerns.

The panel I co-organized with Margaret E. Morris and Sunny Consolvo, “Facebook for health: opportunities and challenges for driving behavior change,” and featuring Adam D. I. Kramer, Janice Tsai, and Aaron Coleman, went pretty well. It was good to hear what everyone, both familiar and new faces, is up to and working on these days. Thanks to my fellow panelists and everyone who showed up!

There was a lot of interesting work — I came home with 41 papers in my “to read” folder — so I’m sure that I’m missing some great work in the above list. If I’m missing something you think I should be reading, let me know!

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