Kay Connelly on Mobile Health Applications for Special Audiences

Today I was torn between attending a mobile health presentation and a mobile libraries brainstorming session. I chose the mobile health one, and was privileged to hear Kay Connelly lead off the Bartels Health Informatics Speaker Series with a presentation on the long drawn out research process involved in designing an effective mobile device application for a chronically ill low-literacy population.

SI launches Bartels Health Informatics Speaker Series: http://blog.si.umich.edu/2009/10/29/si-launches-bartels-health-informatics-speaker-series/

A couple of us were live-tweeting the event, and had folks watching the hashtag stream from the UK, Massachusetts, and North Carolina. Here is the Twitter stream, courtesy of my new fave Twitter tool, What the Hashtag.

#mobhlth
wthashtag.com/mobhlth
Transcript from November 16, 2009

11:11 am pfanderson: WARNING: Live tweeting from Kay Connelly presentation on mobile health application for chronically ill low-literacy population #mobhlth
11:15 am litebulb11: Kay Connelly-mobile health apps for chronically ill low literacy populations #mobhlth
11:17 am pfanderson: hemodialysis patients is population, highly restricted diet. Kidneys clean toxins fr body. 80% can’t adhere #mobhlth
11:18 am pfanderson: Patients told to make a paper diary of what they eat/drink, but can’t read/write. Ahem. #mobhlth
11:19 am SeerGenius: RT @pfanderson: Patients told to make a paper diary of what they eat/drink, but can’t read/write. Ahem. #mobhlth

11:20 am pfanderson: Application based on resrch fr informatics in diabetes, forthcoming bk. Dietary Intake Monitoring Application. Icons for foods #mobhlth
11:21 am litebulb11: Bar code scanner and icons on mobile device to help monitor dietary intake #mobhlth
11:22 am pfanderson: Neat – using barcode scanner in mobile device for some foods. #mobhlth Iterative design – patient feedback, redesign.
11:23 am pfanderson: First question: can target population use PDAs, can they press buttons, play games. Coordination & “pincer” strength, error rate #mobhlth
11:24 am pfanderson: 2nd question: visual acuity. On mobile devices, what size of icons is most viewable / pt prefs. #mobhlth Large icons preferred by elderly

11:26 am pfanderson: Question 3: could patients use a voice recorder? No problem. Yay!!! Elderly needed two hands for this task. #mobhlth
11:28 am pfanderson: Question 4: SDIO Barcode scanners vs bluetooth device pen scanner. Surprise finding: women cdnt use pen because of nails #mobhlth
11:30 am pfanderson: Patients had never realized that most prepackaged foods have barcodes. Had trouble finding barcodes on foods. #mobhlth
11:30 am pfanderson: They made a “game” BarcodeEd to help folks practice finding and scanning barcode foods. #mobhlth
11:32 am pfanderson: Patients were incredibly protective of their PDAs, lived in unsafe environments, high theft. #mobhlth

11:33 am pfanderson: Scanning, even w/o feedback, changed behavior. 60% foods not in open source database. Pts ate more than they thought (LOL) #mobhlth
11:34 am litebulb11: Low literate populations had difficulty reading actual food item brand names, had to describe ‘cereal with leprechaun and rainbow’ #mobhlth
11:34 am pfanderson: Interesting. Pts cdnt voice ID foods eaten because they cdnt rd labels. Voice input was stream of consciousness, unstructured #mobhlth Oops
11:36 am pfanderson: Participants preferred voice input, but performed better with scanning and they didn’t like using it. #mobhlth Turns out they wanted phone
11:37 am amcunningham: interested in health inequalities/ health literacy? follow #mobhlth today

11:37 am pfanderson: She mentioned a website that IDs foods & dietary input from uploaded pics. I want to know what it was!! #mobhlth
11:40 am pfanderson: Patients sorting food cards noticed what they can/can’t eat, ignored side dishes. Awareness was key in training 4 app. #mobhlth
11:41 am pfanderson: For organization of food input, patients preferred a combination of input types – Time of Day & Food Group #mobhlth
11:41 am MarkOneinFour: @amcunningham do you know the context of #mobhlth?
11:43 am pfanderson: Patients liked to show off medical knowledge they’d picked up, and would use jargon they didn’t actually understand #mobhlth

11:43 am litebulb11: Patients proud of obtained medical knowledge, affects design of interface/icons try not appear ‘dumbed down’ #mobhlth
11:44 am pfanderson: Important to make interface sophisticated, not childish, but with tricky balance between what pts liked / what they understood #mobhlth
11:44 am pfanderson: @MarkOneinFour #mobhlth is presentation by Kay Connelly on mobile hlth app for chronic ill low literacy patients at UMichigan
11:47 am pfanderson: Patients could use any nontext widget, as long as they were large enough for vision / dexterity #mobhlth
11:48 am litebulb11: Project abstract and biography of presenter for mobile health app from previous presentation: http://tiny.cc/T93oe #mobhlth

11:48 am pfanderson: Patients favorite part of tool was HOME button (used as an escape/help). NOTE: TV remotes lack this functionality #mobhlth
11:49 am pfanderson: Patients tended to use it either out of home or in home, but not both. Plan: one device for each loc #mobhlth
11:50 am litebulb11: Pride affects choice, patients often preferred interface they used incorrectly #mobhlth
11:50 am pfanderson: Advantage of #mobhlth device is to not attract attention, avoid stigma. But, this population loved showing off. They had cool toy, status
11:51 am litebulb11: Technology is a status symbol, patients showing pda off to neighbors by scanning everything ie paper towels. #mobhlth

11:51 am pfanderson: Patients would show off device by scanning non-edible items, meant muddy data to clean. #mobhlth Pts lie to caregivers to look good.
11:52 am pfanderson: Patients confided in tech geeks because they felt they would not be judged for poor food choices #mobhlth Pts want privacy, not nagging
11:53 am pfanderson: Patients *will* cheat on diet because disease is so miserable. They don’t want to be made to feel bad for cheating. #mobhlth
11:54 am pfanderson: Made it harder to use voice record, accessible only after navigation to food type failed to locate actual food. #mobhlth
11:55 am pfanderson: Organize common foods as easiest to find (ice). #mobhlth

11:57 am pfanderson: Self management and monitoring was empowering. 6 wk trial. Will results persist? Don’t know yet. Pts want to keep device. #mobhlth
11:59 am pfanderson: Future directions: add portion sizes for nonliquids (size comparisons); acceptance by higher-literacy pts? Does design change #mobhlth
11:59 am pfanderson: Can you design for lowest common denominator and find acceptance by others? #mobhlth
12:00 pm pfanderson: OK, she’s taking questions. Anything you want me to ask? #mobhlth
12:01 pm pfanderson: Aha – had star so they could add list of favorite foods. #mobhlth

12:02 pm pfanderson: Suggestion from audience. Use photos not for ID and feedback in realtime, but for validation. #mobhlth Compared data to 24hr recall
12:04 pm pfanderson: Navigation structure – patients were confuse by anything other than linear design #mobhlth Audience: cd use with children?
12:05 pm pfanderson: Brainstorming – taking these design guidelines to create authoring tool for low literacy mobile device apps. COOL!!! #mobhlth
12:07 pm pfanderson: Audience: is it harder to get info to low literacy, low SES, rural, chronic ill or combo populations? Answer: we don’t know yet. #mobhlth
12:09 pm pfanderson: Talking about assumptions of working w/ low SES population, blaming patient for illness. #mobhlth DONE, talk over.

12:17 pm inetnurse: RT @amcunningham: interested in health inequalities/ health literacy? follow #mobhlth today
12:40 pm SeerGenius: @pfanderson thanks for tweeting #mobhlth ! Lovin’ it like Mickey Deez… oops, #notgoodfood.

Mobile-izing the Library

Edward Vielmetti gave a preliminary presentation on the potential use of mobile devices and cell phones for providing library services and resources. Here are my notes from his presentation.

===========================

worst possible interface
– screen is too small
– poor user interface
– keyboarding

Assumption that it is a waste of time to try to adapt because of barriers
Challenges fitting archaic systems into mobile footprint and tech

Bookstore side of the world driving this more than libraries
– Kindle
– revival of Star Trek franchise

Wind back to late 1940s
Vannevar Bush, Memex
trailblazing
production workstation
scientific production
would have taken a whole desk > physical size

What if the Memex was your mobile device?
What would it look like?

Collecting things, not just passively absorbing/reading
– pictures
– record audio
– communicating with others, the authors,
– public production
– with you everywhere
– your access to the World Brain is not just behind yr desk, but everywhere you are

What portions of a library fit in a mobile world?
– source of handbooks, manuals and field books
– ready reference
– ePocrates (drug info and PDR type of tool) (lots of info, frequently updated)
– ie World Radio Television Handbook >> embed this in your radio
– ie Star Trek tricorder (“I’m a doctor, not a librarian, Jim”) device with sensors being informed by books, embedded in the device
– embedded / embodied knowledge “baked into” the device
– fiction becomes interactive fiction
– UNIVERSAL DEVICE
– notion of traditional library activities meshing with mobile devices (ship’s computer)
– upload, download, query
– Hamlet as the right size device > pocketbook
– Google model? will you get back the right answer?
– is it a perfect memory? logging items, will they be there forever and not disappear
– can this advocate on your behalf with others?
– if the first question doesn’t get useful answer, can the device continue searching without your direction?

OK, fictional landscape covered.

To design good user interfaces, we have to think beyond what they can do right now.
Tech is moving fast enough that you can’t catch up, you need to lead
You’d be dissatisfied everytime
Tap into people’s imagination of what it could be

EG. Reading Kafka’s “The Trial” while waiting for jury duty.
– locate
– download
– reader software
– read
– does it fit on this screen?
– has it been digitized?
– rights to it? public domain? licenses negotiated on my behalf

“Any book ever written could fit HERE.”

What if my vision is bad?
– Audio
– text to speech
– ask someone for help to find and they will queue it for me

Planning and decisions developed by REAL patterns of use

How wonderful could it have been, could it be?

From the LIBRARY point of view:

Relationships:
– patron
– support library through taxes, donations
– subscribers
– friends of the library

Similar to Bookstores, but not always equivalent
– “buy NOW”

Metrics
– circulations, not sales
– measures of success?
– “renew all my books now” button >> on phone? why not?
– authentication barriers
– no real API
– would need undocumented system access

patron innovation frustrated by library system complexity

how to empower your patrons to solve your problems?
crowdsourcing yr endusers

customer relationship gives you clear success metrics
libraries lack clearcut success measure with mobile systems

maybe just “we got good press”

Library relations with their communities?
– who cares enough about you to try this out?

Mashup Power
– top ten most circulated books
– what’s hot this week
– mosaic of cover images
– outsider visions of potential

Is the book too big to fit inside the screen? Well, the cover pic will fit.
Browsing the stacks with your mobile device
iTouch interface for browsing

browse the cover art or table of contents for books on the 6th floor via your mobile device
NOTE: words are hard to read on the small screen

navigation tools get you into the building, but not through the building

VIDEO: Harlan Hatcher Graduate Labyrinth

Useful things a library could do:
– wayfinding information
– convert full page maps to handheld application
– race to the location > scavenger hunts in lib
– library as game

Keep it light, or you’ll be frustrated by the device
exit the practical every once in a while

ways people have built systems for mobile use
A. good behavior > some one else has already built reference info for device
– Library (Brown?) menu of relevant items for mobile menu
– discovery and sharing of tools created by your users
– risk: people sometimes remove apps they’ve made
– systems that are well adapted to mobile access
– Buses >> system down for 6 weeks at coldest time of year, politics
– parking spaces >> was not launched properly , system use resulted in access cut off access to the data
– partnerships, data sharing, who owns/supports data?
– intellectual property murky for much of this
B. Beyond technical issues of squeezing things onto small screen
– Kindle > does it fit in your pocket?
– small enough to carry
– large enough to see and type
– Memex
– reserve items via device >> texting (Like TrialX for CTs)
– reading something, want to fetch other item, “Buy Now” button as “Reserve Now”
– capture trail of what I’ve already read
– Reference collections
– what sorts of materials
– miserable user interface to e-ref sources
– logins, permissions, interfaces
– accessible formats
– Using SMS or Twitter for query/access
– How much paper would we save by putting bus schedules onto mobile devices?
C. Private wiki
– personal library
– papers
– articles
– chapters from books
– quotations
– snippets
– commonplace book

Devices: size comparison
contrast mobile devices with comptuers

What sort of things are in libraries that could be used on mobile devices?
(What are books?)
phonebooks
what happens to the newspaper when it isn’t paper anymore?
reading on the bus

what can you fit on a 3×5 card?
mobile device as business card
postcards
writing changing to fit in small spaces
– postcard poems
– twitter novels

How libraries interact with people who are not their typical patrons?
– children’s rooms, how to find all libraries with nice children’s rooms in geographic area
– locations/hours of local libraries while traveling
– have our patrons shifted with mobile population?

using library catalog on mobile device really tells you how bad your search itnerface is

Wish I had examples of wonderful interfaces, but I don’t right now. They are coming.

Different information needs, different information access

Questions that can be reframed if you assume that people have no computers

===============
Q&A

NYT article: mobile device to identify plants along a park path
birding

device add-ons
– pedometer
– GPS maps
–

reference
– people
– good set of friends to ask good questions
– chacha
– trialx
(take people who are too helpful with a grain of salt – they might have a hidden agenda)

Match making service: news stories sources match up with reporters writing on topic

Mobile Education Opps and Apps from UM’s Soloway

I’ve been on a real mobile kick lately. Dusting off Rheingold’s book, reading up on mobile tech for library reference, and much more. I’m not the only one! UM Prof. Soloway has come up with software to help facilitate using cell phones as education technology devices in the classroom. Check it out – he’s a bit of a character.