56 COMPUTER Published by the IEEE Computer Society 0018-9162/14/$31.00 © 2014 IEEE
STANDARDSINVISIBLE COMPUTING
By moving beyond logical data collection and engaging people on a
subconscious and emotional level, computing technology could change
cultural norms and thereby more effectively motivate lifestyle changes
that prevent disease.
C
omputer science has
been an integral part
of healthcare for
decades. Networking
and communications technologies
support telemedicine, bringing
expertise to remote locations to
aid in surgery, physical rehabilita-
tion, and home care. Advanced
graphics applications enable
brain and body imaging. Data
analytics and information visual-
ization foster new understandings
about relationships in medical
records—for instance, between
drug interactions and patient
attributes.
1
Human–computer
interaction has made the operat-
ing theater
2
and emergency room
safer
3
and medical devices easier
to use and more precise.
4
It’s fair
to say that innovations driven
by CS help more people receive
better healthcare, recover faster,
and return home sooner.
Thus far, CS has had less impact
on proactive health, or what we
call “wellth”—that is, practices that
lessen the chances of illness and im-
prove overall physical and mental
performance. Given the alarm-
ing rise in obesity, type 2 diabetes,
cardiovascular disease, and other
preventable conditions, we believe
that using computing technology to
support individual aspirations for
greater well-being is just as impor-
tant to society as using it to improve
ways to cure disease.
Wellth Creation:
Using Computer
Science to Support
Proactive Health
m.c. schraefel, University of Southampton
Elizabeth F. Churchill, eBay Research Labs
The computer has become the generic tool in oces and homes around the
world—nearly no desk is without one. However, the way workspaces are cur-
rently designed, with the computer on a table and the user sitting alone before
it, has strongly contributed to the modern sedentary culture. As more work pro-
cesses get digitalized, there’s even less need to get up—to get a document or
book, pick up a fax, walk to the printer, and so on. This is certainly not healthy.
However, the emergence of many new information and communication technol-
ogies, from ubiquitous displays to tablet computers to wearable devices, pro-
vides us with a chance to fundamentally redesign ICT to move away from
sedentarism—a leading goal of proactive health.
—Albrecht Schmidt, column editor
NOVEMBER 2014 57
IS THERE AN APP FOR THAT?
When it comes to proactive health,
the majority of interactive technol-
ogy developers and researchers have
focused on developing apps that are
very good at doing what computers
do best: counting. Apps connected
to increasingly cheaper and sophis-
ticated sensors tell us how much we
weigh, how fast our hearts beat, how
much we sleep, the number of steps
we take. Other apps count the ingre-
dients in our food: grams of protein
and carbohydrates, vitamin content,
number of calories.
These apps generally return raw
data to the user in the form of, say,
a histogram of steps, a line graph of
weight, an average heart rate, a com-
parison of today’s and yesterday’s
calories. But what problem are these
counts actually solving?
There’s a popular assertion—and a
growing belief among app developers—
that through this data people will learn
more about themselves and somehow
get healthier, perhaps simply by doing
more of a good thing. But more isn’t
always better.
Many readers are likely famil-
iar with “workplace challenges”
designed to promote exercise—for
instance, to increase steps each
week using a step-tracking app or
wearable device. After a while, as
you grind out thousands of steps
each day to meet the next thresh-
old, the experience becomes dull
and repetitive—you feel as if you’re
chained to the sensor. But what are
enough steps? What does a massive
step count accomplish? Nothing,
actually. Research suggests that
7,000–9,000 steps per day is suffi-
cient for disease mitigation.
5
Similar critiques have been raised
about calorie counting. It’s easy for
an app to match a food source to a
database with nutrition informa-
tion and, of course, calories, but
weight loss isn’t all about reducing
calories. Many people regain weight
after dieting, and this yo-yo effect
often isn’t due to lack of willpower:
rather, it’s attributable to insufficient
nutritional knowledge—something
a calorie-counter approach doesn’t
take into account.
BEYOND BEHAVIOR CHANGE
Despite their popularity, existing
proactive health apps are only reach-
ing for low-hanging fruit. ICT tools
are needed that go beyond logical
data collection to engage people on a
subconscious and emotional level.
A recent pilot study we conducted
revealed that most runners and cy-
clists use heart rate monitor watches
to motivate completion of the activ-
ity, not to monitor their real-time
performance. Simply having an
HR watch, it seems, can trigger our
desire to align practice (“go for a
run”) with how we perceive our-
selves and want to be perceived by
others (“look fit”).
But what about those who don’t
run or cycle? How can we reach
these individuals? Even without the
data generated by heart monitors
and other self-tracking devices, ICT
systems can draw on other kinds of
information to create wellth.
Computing devices can access
a plethora of user data from social
media, Web activity, calendars, GPS
logs, and the like as well as associ-
ated contextual information—for
example, about current news,
weather, and traffic conditions. Inte-
grating this personal and contextual
data with machine learning for
sense making in the proactive health
domain remains, surprisingly, a blue
sky ambition—and an obvious deep
seam for researchers to explore.
Various APIs enable apps to copy
data from one another—for ex-
ample, a running app can display
your weight results from a Wi-Fi–
connected scale in the same screen.
You can also patch a feed from one
app into another to carry out cer-
tain actions: “If my weight exceeds
X, send text message to friend indi-
cating I owe him 20 quid.” However,
such simplistic approaches aim to
induce behavior change without pro-
viding any context.
It would be more useful to com-
bine relevant personal data with
related contextual information to
support informed decision making—
that is, to make better normal and
normal better. For example, suppose
a system could analyze a user’s cal-
endar events and sleep data over a
month and tell her upon waking one
morning, “Honey, you really do need
to slot in some rest; you’re burning
the candle at both ends. Look, you
have two hours without meetings
today and it’s not going to rain: why
not go for one of your favorite walks
around campus?”
Such a wayfinding approach goes
beyond trying to modify our behav-
ior by presenting us with simplistic
numerical targets; rather, it illumi-
nates paths to wellness that we’re
more than happy to take but may
not see on our own.
IT’S ABOUT THE SYSTEM,
NOT ANOTHER APP
While behavior change certainly
has a role to play in well-being, fo-
cusing on the individual ignores the
environment and ethos in which
individuals operate. As a systems
science that examines complex
operations, interactions, and infra-
structure, CS could be leveraged to
explore metalevel questions about
proactive health. How can we use
technology to support a new cultural
norm that values achieving and sus-
taining well-being?
If the goal of proactive health
is to change the status quo, to
make better normal, that means
eliminating sedentarism, a lead-
ing cause of cardiovascular disease
strongly linked to overweightness
and obesity as well as poor cogni-
tive function.
6
Given that a person
spends on average 9.3 hours per day
seated, most of that at work and un-
interrupted, how can we use CS to
promote a more active lifestyle? A
conventional approach would be to
58 COMPUTER
INVISIBLE COMPUTING
employ “persuasive technology” to,
say, set off an alarm every 20 min-
utes to remind someone to move.
Can we do better?
To impact the problem at scale,
we must consider the infrastruc-
ture that supports the cultural
norm of sedentarism.
For example, if one solution is
more “walking meetings”
7
outdoors,
what kinds of tools would robustly
support mobile idea generation?
Could we create ruggedized digital
white boards in the wild? Can we de-
velop a system that captures sketches
on the go in nanopaints on building
exteriors and transmits them to the
appropriate parties for revision?
Similar questions can be raised
about changing other cultural
norms. If eating more locally
grown vegetables is beneficial,
how can we use CS to make food
production more local and sustain-
able? Is there a role for hydroponics
and indoor Internet of Things–
connected lighting in the built
environment? Do we need new
ways to deliver the knowledge and
skills required to care for microcli-
mates and microenvironments?
GRAND CHALLENGES FOR
ICT IN PROACTIVE HEALTH
At a recent Dagstuhl Perspectives
Workshop, “Exploring Interdisciplin-
ary Grand Challenges for ICT Design
to Support Proactive Health and
Wellbeing” (www.dagstuhl.de/de/
programm/kalender/semhp/?semnr
=14272), participants discussed
potential proactive health systems
and techniques as well as the meta-
level implications of design choices.
If taken to their logical conclu-
sion, what type of culture would
such technologies foster? Does that
align with goals like high qual-
ity of life and democratic liberty?
The workshop also considered
frameworks for building out and
evaluating designs. The consensus
was that designs should evolve from
unconscious to conscious and from
logical to emotional engagement.
Attendants included experts in
medicine, psychology, sports sci-
ence, and sociology as well as CS,
highlighting the multidisciplinary
aspect of proactive health.
A
s a new and comple-
mentary paradigm to
healthcare, proactive
health opens up exciting system
design opportunities and challenges.
Properly harnessed, computing
technology could have as great
an impact on motivating lifestyle
changes that prevent disease as
it has had on existing medical
practices to care for those who are
already sick. To be successful, how-
ever, researchers must carefully
consider novel epistemological and
methodological requirements.
This year’s Dagstuhl workshop
was a first attempt to broadly engage
the CS community as well as ex-
perts in other fields to make the
world healthier by changing cultural
norms. We look forward to continue
working toward this goal.
References
1. T.D. Wang et al., “Aligning
Temporal Data by Sentinel Events:
Discovering Patterns in Electronic
Health Records,” Proc. 26th Ann.
SIGCHI Conf. Human Factors in
Computing Systems (CHI 08),
2008, pp. 457–466.
2. B. Ma et al., “A Laboratory
Comparison of Computer
Navigation and Individualized
Guides for Distal Radius
Osteotomy,” Int’l J. Computer
Assisted Radiology and Surgery,
vol. 9, no. 4, 2014, pp. 713–724.
3. L. Wu et al., “Supporting Crisis
Response with Dynamic
Procedure Aids,” Proc. 2014 Conf.
Designing Interactive Systems
(DIS 14), 2014, pp. 315–324.
4. A. Cauchi et al., “Safer ‘5-Key’
Number Entry User Interfaces
Using Differential Formal
Analysis,” Proc. 26th Ann. BCS
Interaction Specialist Group Conf.
People and Computers (BCS-HCI 12),
2012, pp. 29–38.
5. C. Tudor-Locke et al., “Revisiting
‘How Many Steps Are Enough?,’”
Medicine & Science in Sports &
Exercise, vol. 40, no. 7, 2008,
pp. S537–S543.
6. A.A. Thorp et al., “Sedentary
Behaviors and Subsequent Health
Outcomes in Adults: A Systematic
Review of Longitudinal Studies,
199 6 –2 011,” American J. Preventive
Medicine, vol. 41, no. 2, 2011,
pp. 207–215.
7. D. Clarkson, “Walking
Meetings: Taking It to the
Streets,” The Guardian, 2 June
2014; www.theguardian.com/
lifeandstyle/2014/jun/02/
walking-meetings-work.
m.c. schraefel is a professor of
computer science and human per-
formance and leads the Human
Systems Design Lab in the School of
Electronics and Computer Science at
the University of Southampton, UK,
where she is also a practicing nutri-
tion and strength/conditioning coach.
Contact her at mc+ieee@ecs.soton.
ac.uk or follow her on Twitter at @
mcphoo.
Elizabeth F. Churchill is director
of human–computer interaction
at eBay Research Labs in San Jose,
California, as well as vice presi-
dent of ACM SIGCHI. Contact her at
churchill@acm.org or follow her on
Twitter at @xeeliz.
Selected CS articles and
columns are available for free at
http://ComputingNow.computer.org.
Editor: Albrecht Schmidt, University of
Stuttgart, Germany; albrecht@computer.org