Tag Archives: users

Why are Ambient Assisted Living Technologies so Difficult to Develop?

I was appointed as one of the external reviewer of Jean Hallewell Haslwanter´s PhD dissertation with the title “User-Centered Development of Sensor-based Systems for Older People”. I must say that this was indeed an interesting thesis to read and I strongly recommend it for anyone who is interested in healthcare technology and user-centered design.

Ambient Assisted Living (AAL) is a technology that has been proposed to help society with problems related to an ageing population, as it could support older people to live at home instead of moving into elderly homes. However, despite the fact that many IT projects and companies have been working with the development of this technology, and large amounts have been invested in AAL, few such technologies has reached the market. In her thesis, Jean Hallewell Haslwanter addresses the issue from a user-centered design perspective and her work aims at understanding why AAL technologies have proven so difficult to develop.

The thesis has a substantial empirical contribution as it studies the development of AAL systems. One interesting finding is that the complex and multifaceted descriptions of the users fade away as the project continues, and is replaced by stereotypes of older people. Other contributions include recommendations for practitioners working with development of AAL technology.

Jean Hallewell Haslwanter’s dissertation is a monograph, but she has 13 research papers that are previously published. Many of the papers are conference papers, of which many appear in highly ranked international conferences. There are also conference papers that have been turned into journal papers. If you are interested you can find these publications online at the link.

My PhD thesis: Usability – Who Cares?

It’s been almost seven years ago that i defended my PhD that is a collection of eight papers related to the establishment of User Centred Design (UCD) in organisations when developing IT for work. You find the thesis in the university system Diva.

The fundamental idea on which the thesis work is is based is that future work situations, usability of systems, and users’ needs, must be considered when developing computer systems for work, in a manner which involves the entire organisation. Usability needs to be a part of, for example, the organisational culture, strategy documents, budgets, and methods for procurement. During my PhD work I participated in large action research (see blog posts about this) projects in eight different organisations.

It took me eight calendar years to finish my PhD education (!), but four years of full-time work since I got three of my children during this period. We have paid parental leave in Sweden, and I was off for a bit more than a year for each kid.  My supervisor Jan Gulliksen was very engaged, and the best supervisor I could get. Towards the end of the process I was a single mother of three boys, and with the support of my parents and collegues I managed to wrap things up.  This was not easy, as you can imagine. But somehow this very stressful life situation made the thesis writing the fun part of life! I honesly also think that the text became better since I just wrote down things I have learned without any aim of it being perfect or complete.

The thesis has three research questions:

  1. What happens when UCSD is introduced in a public authority?

I was also interested in the values and perspectives of people involved in the organisation as well as how UCSD can be introduced through new methods that affect the values and perspectives of the stakeholders including the system developers in the organisation. Therefore, this thesis also aims at understanding the following questions:

  1. How do perspectives of stakeholders in systems development projects affect the work with UCSD, usability and users’ health in the organisations studied?

The final question addresses the issues of how we can address the introduction of UCSD and change perspectives:

  1. What new methods can be used to introduce UCSD and to influence perspectives?

 

Many answers to the questions in the thesis are still valid today, and it is indeed very difficult to establish a human centred perspective and UCD in organisations. One can wonder why this is the case? Some of my findings presented in the thesis are presented as the problems with establishing UCD when developing computer systems for work:

Some organisational problems found in the study presented in papers Sandblad et al (2003) and Cajander (2007).

Organisational problem Description of problem
Focus on surveillance and control ·    Detailed supervision of work and work performance through computer system.

·    Some saw surveillance as contributing to productivity

·    Some expressed that surveillance implied mistrust from management level
Administrative work was regarded as trivial ·    It-professionals claim that they have a good picture of case handling and core business.

·    Administrative staff believe that their work is much more complex than is generally understood

 
Development of IT systems based on technology and process descriptions ·    Abstract models of work as flow diagrams guide the development of new computer systems.

·    This has lead to some inflexible computer systems that shape work

·    Situated nature of work (Suchman, 1987) not taken into account
IT-department and users – two separate worlds ·    Alienation between groups and little understanding of the needs of the other group
Usability in systems development ·    Little or no usability activities in system development.

·    Few usability goals in the requirements specification

·    Usability activities often limited to test

·    Usability perceived as a vague and unclear concept

I also explore some (at the time of the thesis) new methods to work with the establishment of UCD:

  • System developers doing field studies to see the context in which the computer systems they build is used.
  • Usability coaching
  • Usability Index
  • Management’s perspectives on usability
  • Collaborative policy writing

I hope that some of you who work with usability take the time to skim parts of the thesis!

 

 

 

Working with Usability in Scrum Projects – what Usability Activities are Used in Practice?

A few years ago Yuan Jia worked with Marta Larusdottir and me as a master student doing her master thesis study in our research project on Agile development and UCD.

There was lack of studies describing to what extent different user centred methods were used in Scrum projects, so this became the topic of Yuan Jia’s master thesis, and which resulted in a conference paper. I remember that we had a very good collaboration with Yuan Jia, who now is a PhD student in the US.

When designing the study we quickly ran into problems with the number of respondents to our web based questionnaire. We did not have the mail contact information to people in organisation working with Scrum and user centred design. First we distributed the survey through the Uppsala Tax Office and LokaIdelen which is a website offering information to companies in Sweden. I also remember Yuan Jia’s long lists of company names and phone numbers as she systematically contacted company after company. Tedious work, but to be honest research work can be very much administration from time to time. In the end we had around 50 people who answered the survey 🙂

The survey has some interesting results, se Figure below. The most commonly used usability technique in Scrum projects is workshops, followed by lo-fi prototyping, interviews and meetings with users, all used by more than half of the participants.

One can note that all these usability techniques are informal, meaning that these techniques can be used quickly without much preparation. Formal usability evaluation with users is a highly ranked technique by the participants but not commonly used by them.

 

the-usage-of-usability-techniques

 

We presented the paper at the Human Centred Software Engineering Conference (HCSE) in 2012.

You find the paper here.

 

Interviews with Cancer Patients Reading their Medical Records Online

When medical records online was launched in Uppsala County Council a few years back many health care professionals were concerned, to say the least. There were for example some very upset discussions especially regarding cancer patients and medical records online, and the possibility to get bad news through a web page.

There were also critical incidents regarding patients reading their test results and getting a cancer diagnosis online, as in the screen shot that is the featured image in this blog post. The article is a Google translation from Swedish, and the original article can be found here.  The news article describes the story of a woman who got to know about her the return (?) of her breast cancer through logging in at a web service. This specific critical incident occurred in 2015.

So the question is:

Is reading your medical records online really a good idea for patients with diseases such as cancer? What do cancer patients in general think about the system? Is it useful for them?

As a result of this turbulence around medical records online and cancer patients DOME did an  interesting study with interviews with 30 cancer patients. I did this study together with my PhD student Hanife Rexhepi (I’m co-supervisor), Associate Professor Rose-Mharie Åhlfeldt and Professor Isto Huvila. We presented this study at Vitalis, and you can see the presentation here (in Swedish), we wrote a Swedish white paper on the study found here and also a journal paper in the Health Informatics Journal.

In the study we found that some cancer patients use the system on a daily or weekly basis for several reasons:

  • They are curious about what it says in the text, and in the test results.
  • To prepare for the next appointment with a physician.
  • To get a feeling of being in control when it comes to their decease.
  • As a memory aid when looking at what has happened so far with their decease.
  • To be able to understand what the physician said in the meeting.
  • To read up on the latest test results, and to compare to previous results.
  • To get the exact information, and not an interpreted oral version.
  • To decrease the waiting times in health care

One of the worries that health care professionals have is that patients would become worried, and some patients said that of course it is worrying to read about the decease sometimes.

“If we can handle to live with all these deceases- we can handle to read about them too”

In our study almost all patients choose the option to see everything at once in the system and not to wait until the information is signed by a doctor. This is also confirmed by statistics that say that 98% of all patients want to read as soon as possible, and do not want to wait for the information to be signed by a doctor. Many patients in our study describe the waiting for results as the most difficult part of being ill, as one patient said:

“For me it is good to read. It is much worse to go around and wait. No one wants to tell you anything.”

One of the more controversial results from the study was that some patients preferred to read about negative development in their cancer, or the occurence of cancer online, as in this quote:

I personally want to know. Even though it is tough. It is not less tough to get to know it a few days later, or by someone who wraps the bad message inside mumbo jumbo words to soften it and says that it is not too bad and so forth. No, I want straight answers.

One should note that all 30 patients in the study thought that being able to read the medical records online is a good reform, and that the system should exist as a possibility for those patients who want it.

I have had a meeting the Oncology department at the hospital to discuss the possibility of doing a follow-up study on patients reading their medical records online. Some of the things we want to understand is the use and non-use of the system, and how it affects patient empowerment. We also need to do a follow up study because there is a risk that the people that we interviewed were early adopters of the system, and we want to find out what the mature users think.

So there are more studies to come in this interesting area!

On the Future of Software Engineering by Ivar Jacobson

I listened to a very interesting key note by Ivar Jacobson on the future of software engineering. Many of the things he said were spot on true, and some were a bit provocative and I disagree, but the talk was still very interesting.

Ivar Jacobson starts his key note with a historical overview of the history of software engineering, and the presentation included reflections on organisational learning and good practices. According to Jacobson there has been a few different paths in software engineering, but very little learning from past experiences. Software developers are not trained in learning from the past, and to rework and improve. They are trained in doing new things. I think he has a point here, and this is a wider phenomena than something unique for software engineering:

“Every new path starts by throwing away what you had and starting all over with new vocabulary, “new” practices, new gurus”

When talking about Agile, Ivar Jacobson claims that it is definitely a good practice. He claims that if you are a methodologist you need to be out of marketing, otherwise you are out of the game, and Agile has succeeded here. The method also needs to be accepted and appreciated by the software developers, and there is where Agile is successful. However, he also claims that many of the good practices and things we learned about software development was thrown over board when moving to agile:

“I am a firm believer in Agile, but lots were lost when we moved to Agile.”

One cornerstone of learning in an organisation, according to Jacobson, is the common ground and a common vocabulary. And we need methodologies, processes and a common vocabulary to coordinate the work with ITC in organizations. Work that includes several thousand people cannot be only creative design.

We also need to know more about how software developers learn, and how the marketing of new methods work. I really agree with this, and studies of learning in relation to software engineering is really a part of my interest. Ivar Jacobson continues by  saing that people learn through using, and working with methods, and he is reflecting on the use of books as a source of learning:

“People buy the books, but they don’t read them. How do we know what they know?”

Finally Ivar Jacobson presents the concepts of Essence, which is built on previous methods and ideas. According to Jacobson Essence is:

Essence – a standard that defines the smallest set of concepts that are common to all software projects – helps embed agile professional practices and governance across an organization for sustainable, scalable and responsive solution delivery.

The future of software engineering is human centred, of course, but there is still some way to go before we are there . According to Ivar Jacobson the way forward is to create a learning organisation, that includes a kernel of common concepts and knowledge. I agree with him completely, and the problem is how to create this situation. Perhaps action research and practice oriented research is the answer to this question?

 

The Volkswagen Scandal: Values and Software Development

In 2015 it was revealed that Volkswagen had deliberately cheated with environmental tests, and that their engines did not fulfil the requirement of pollution. This was indeed a big scandal! But one can wonder how it could happen that such a well reputed company makes such bad and unethical decisions? The presentation that I listened to at the Human Centred Software Engineering conference did not give an answer to this question, but instead talked about what we should do in software development to ensure that these things do not happen. The paper is called: “Do you own a Volkswagen? Values as Non-Functional Requirements”

Friedman’s ideas of Value sensitive design has been around since the 1990’s, and the idea behind it is really good. We should be aware of our values and incorporate them in systems development. Cockton has also made some contributions in the field of value, but he looks more at the value perceived by customers than the value of the systems developers. I also worked some with values as my first area of research, and did my licentiate degree on Values and Perspectives Affecting IT Systems Development and Usability work. My focus was on what values are at the core of the decisions made in companies when it comes to software development. Not surprising money, time and automation were values that collided with the values of user-centred design.

One can wonder why this way of thinking is not present in software development processes such as agile development? It feels like the value sensitive design and the ideas behind that are completely off, even though agile generally has a very strong focus on working teams, humans, communication and leadership – not to mention speed. 

Perhaps it would be easier to discuss values in software development today than ten years ago due to the discussion about sustainability? Perhaps things have matured and we have another way of thinking than before? Hmmm. Or perhaps not?

Robots Instead of Health Care Professionals??

I listened to the introductory key note from the conference Human Centred Software Engineering by the very inspiring Danica Kragic on social robotics.

Clearly robots such as avatars of humans will influence work very much in the future. One of the areas of application is health care. Danica Kragic mentioned health care services such as Cognitive Behavioural Therapy, and research has indicated that this might be a possible future avenue. Physicians would collaborate with robots in their work, and part of the work would be replaced by robots such as some part of the therapy.

Hmm. One can wonder what the reactions from physicians would be if we start doing research on replacing them with robots or machines? And how would the patients react to robots? Perhaps not as negative as one could think?

One can also wonder how the professional competence of health care professionals can be transfered to robots?  Is this possible?

BTW: If you haven’t listened to Danica Kragic’s Sommar, I highly recommend it (in Swedish only, though) ?

“How do we design Work 4.0? “

 

Technology change human work, changes responsibilities, change decision making and we are losing knowledge and competencies, according to a paper by Holger Fischer and Björn Senft presented at the Human Centred Software Engineering Conference. Their research is then on how organisations should work to ensure that the systems build to support this work are usable, and conform with standards. Unfortunately the paper does not present the silver bullet to how this should be done ;-).

This research is indeed very relevant for my research group as it is a complex issue to design ICT that works well. Hmm. But after a few years in the area of ICT and work, we are getting a bit disillusioned about the state of the art when it comes to ICT at work. Or as one of my colleagues in the group joked :

“I do research on how to introduce new ICT systems for work in organisations without breaking the organisation down “

 

Publication: Contextual Personas to Understand Digital Work Environments

We have developed a new method for including the user perspective and the user’s digital work environment in software development.

The method is an adoption of the persona’s method where work environment aspects are included, and can be used when designing or procuring IT systems.

The method describes the holistic uses situation of a person with the 10-20 different IT systems that are used at work. It is based on a well known theory by Karasek and Theorell regarding control, demand and support in relation to stress.

For further reading see our book chapter on the topic. It is published in a Springer book.