For my graduate thesis, I wanted to explore alternatives to the quantification of health and the role of wearable technologies. Fitness trackers are presented as the best way of engaging with health and managing physical activity. But a purely quantified and mechanistic view of the self has limitations.
// What motivates behavior change with regards to fitness?
// How might I design practices for intrinsic motivation regarding fitness and health?
// How can cultural probes mediate people’s understanding of their own motivations?
// What are the roles of 'control' and 'conversation' through and with technologies?
// How might qualitative and quantitative methods be used to study qualitative and quantitative aspects of understanding experiences?
// What alternative models of the human can user-centered designers assume while conceptualizing solutions?
#research through design
Qualitative Research - Interviews
I conducted hour-long interviews with 15 people who used or still use fitness trackers or other m-health applications. Interviews included open-ended questions, directed storytelling and a 'break-up/love letter to their device or app. The overall pattern was common to lots of people even if the details and the shape of their motivation over time varied. The initial excitement of getting a new gadget was followed by a sharp drop in engagement. Within 3 months, usage falls drastically and very few used it beyond 6 months.
Interviews showed that fitness trackers are unable to recognize and address changes in people’s needs and motivations. Existing services are inflexible and don’t provide sustained value. Conditions for deeper change are not created. Apps don’t help people think about the connections between fitness and time management, financial management or the social aspect of life.
“For the first week, I did pretty well. And then I was pretty inconsistent and then I felt pretty discouraged. Mostly because I was able to see my past record falling short.
"The purpose of having bars is to compare yourself to the past and feel a sense of achievement. But there’s no improvement because it (the walk to and from work) is the same everyday. Unless I walk somewhere else for no reason...just to fill up the bars."
Quantitative Research - Sentiment Analysis
To find out more about why and how people bought and used fitness trackers, I wrote a Python program to parse through 33,688 Amazon reviews of the top seven products. By using an open source Natural Language Toolkit, and developing a sentiment analysis tool, I found that those who abandon fitness trackers blame themselves or the physical product for not being able to change instead of putting the onus on the design of the service.
Decision Sciences Research
Through a class on Risk Perception and Communications, I examined how people perceive and evaluate the risks of physical inactivity and of security issues around fitness trackers. Specific learning shaped my ideation in the next phase. Doctors’ biases affect how they communicate risk-based information to patients. The affect and availability heuristics explain why people don’t perceive physical inactivity to be risky. Means objectives are also highlighted more than fundamental objectives, creating a myopic understanding of health
I was simultaneously interested in the philosophy of technology and the history of the concept of fitness. I studied Weight Watchers, fitness trackers and workout tapes and applied Foucault's Technologies of the self, Latour's Actor-Network Theory and Mol’s theory of the Logic of Care to each of these.
I surmised that technologies of the self also need to mediate meaningful and self-reflective conversations with people. Designers can lead the conceptualization of digital networks, artifacts, practices, and service interactions. Conversations within the logic of care influence internal conversations that people have with themselves. These in turn are affected by conversations or ‘scripts’ that technologies impose and affect behavior change. Therefore, a careful consideration of the technologies that people use can change how they think about themselves beyond just externalized short term behavior.
Whilst conducting research, I was thinking of possible ways to make the theories concrete. The idea of the models of humans fascinated me and I was interested in frameworks that would help me extrapolate service ideas.
This research led me to create phases of an ideal user journey; beginning with before self-awareness, then self-awareness, action, reflection and finally ending the relationship with the service. I used this as a frame to design new technological artifacts along a scale from ‘Prescriptive’ to ‘Background’. They were designed as solutions for problems that people face at the different stages and included small personal artifacts and ideas for large product-service systems. Two example ideas are explained here to illustrate the diversity of concepts.
This concept promotes action through implicit data visualization (Action-Implicit). It is digital watch with a circle that gets misshapen if you don’t do physical activity. This leverages people’s innate desire for symmetry and order.
Using explicit information to motivate action (Action-Explicit) this is a concept in which people belong to teams and through exercise, contribute anonymously within those teams for the benefits of groups without the pressure of competition.
I interviewed a practicing doctor in the field of sexual health and HIV medicine, a game designer and a eurhythmics professor, who all focus on different kinds of motivation. The key takeaway was that people like to and need to take active control of changes in their behavior. This runs counter to the popular design discourse around convenience and was something I was keen to explore.
"To appeal to people and motivate them, you have to get at their core fantasies." - Greg Costikyan
"I try to get students to recognize something about themselves...challenging them to be a better version of themselves and to reveal themselves." -Stephen Neely
"Based on my experience, intrinsic motivation as a result of reflection formed through conversation is more effective than just reducing barriers to taking medication and making it more convenient." - Dr. David Pao
Cultural Probe Development
I started by conceptualizing the overall system and ideating particular service moments. I then made low fidelity prototypes of the probes, then refined the form to higher fidelity probes, wrote instructions and created kits for deployment. In the last image you can see how one of the probes evolved from cardboard to acrylic.
The first probe is a collage. Participants were provided with images representing different kinds of fitness practices, environments and social situations. They were asked to make two collages – what fitness means to them currently and what they would like their relationship with fitness to be in the future. This allowed them to be objective about their present and at the same time, think about their ideal future self.
The second probe involves Personas. Based on the previous user interviews, I created 5 personas and included quotes across the spectrum. Participants were to identify quotes from different personas and paste them onto the ‘Me’ sheet. Most participants found this really helpful in understanding their own motivations and dichotomies within how they feel about fitness.
The third probe was inspired by Day in the Life of exercises. Participants were asked to map out what physical activity they did in the day. Based on where they marked in on a spectrum, it would show up on the yellow (for positive) or blue (for negative) sheet of paper. Each of these had questions to reflect on.
The fourth probe was inspired by Georgia Lupi and Stephanie Posavec’s Dear Data project. To track behaviors over a week, participants were to take screenshots of fitness tracking apps that they use and annotate over. Like the first probe, I asked them to extrapolate into the future too- in this case, just the next day.
This probe, called 5 Whys, is based on Toyoda’s method of asking why - 5 times – to uncover a production issue. Here, I asked participants to write why fitness was important to them follow each reason down to articulating the base reason. People said that they had the most difficult time doing this but it also lead to some of the most interesting insights. One of the participants said it made her realize how other people’s fitness affected her own views.
The sixth probe is intended to help people uncover their mental models around fitness by thinking of the parts or actions first, and creating a whole. The instructions were about filling the actions on the smallest cards, followed by habits and then social practices. The instructions were intentionally open-ended because I wanted to see how people would respond. I think this didn’t work as consistently as the other probes.
Finally, I asked people to write down their reflections in a journal. The size of the pages of the journal increase with each probe to encourage people to reflect more over time. The animals on the corners are inspired by a technique programmers use for debugging. They put a rubber duck on their desktop and as they debug, they talk out loud to it. This forces them to explain their code to a novice and helps them find errors in logic. Interestingly, one of the participants said he liked it because it made the writing process less intimidating. Another participant said that writing was actually easier than completing a probe. This could indicate that the probes encouraged people to externalize their thought, and hence, reflecting on it was made easier.
My final proposal was a program to build intrinsic motivation. It is meant for people who have a hard time keeping themselves motivated and want to be engaged with managing their fitness. In this 6-month program, people use various micro-services in different weeks. Some of these use fitness tracking technology, while others are analog. The focus isn’t on the nature of the physical activity but on the self-reflection that accompanies it. The self-reflection components are individual experiences for the initial period, supplemented by group support and followed by individual engagement. Each activity is backed by theory in terms of the meta-activity. In a way, this is a training plan for intrinsic motivation for physical fitness. The service components are mapped below with the corresponding meta-activities