Principles of mHealth Design I: What are we doing … and who are we doing it for?

David Gustafson, PhD Donna Spruijt-Metz, MFA PhD

• What are you doing? (Scope) • Who are your internal and external customers (and why is it tricky to identify them)? • Why is it important to understand your customers, internal and external? • How do you get into shoes of the ‘customer’ to develop systems that best ‘fit’ the customer? • How do you use the knowledge that you get from all this?

How this session works

• Take 5 • Nuggetology

• • • • Be creative, open-minded And PRECISE (With the option to build on….) Scope will depend on ‘customers’…

Identifying the internal ‘customer’
• What’s an ‘internal’ customer?
– If you are an engineer, the health scientist on your team might be an internal customer (i.e. your own colleagues and staff) – Your university, tenure committee, department chair, or higher-ups in your business might be your ‘internal’ customers. – Your funders might, in some sense, be ‘internal’ customers

• Internal customers might have different expectations, needs, desires, timelines and endpoints in mind

Conflicts between Customers
Promotion = 1st AUTHORSHIP IN JAMA
Has the OMG(oodness)!! But I need to accelerometer in be TRANSDISCIPLINARY that cell to take this able phone been MOBILE validated? HEALTH out into the SYSTEMS DYNAMIC field and use it RESEARCH WOW!!


Proof of concept! Done!

Is it the most up-to-date technology?

Identifying the external ‘customer’
• Let’s say we are developing a ‘second skin’ of some type for obesity interventions in urban inner city Los Angeles youth. • Who is the ‘customer’? • Beyond developmental stage (impacts: Cognitive function and emotional control, thus learning styles, acceptability of various functions) • Beyond ethnicity (impacts: Approach, acceptable diet and activity recommendations, language) • Beyond SES (impacts: Everything)

Identifying the ‘whole’ customer
• eliminates a lot of discussion (arguments?) about what is or is not a system.

• opens creative solution space by seeking solutions to achieve bigger ends

• provides a way of considering all aspects of reality

• is a reminder that independence of systems is an illusion
Dr. Gerry Nadler

Dan Stokol’s Early Vision of Socioecological Systems

Patrick, Intille & Zabinski

‘Second Skin’ in a System
• The case of KNOWME

Your case study

Why is it important to understand customers, internal and external?
• • • • • • • • Assets Deficits Perceived (and empirical) needs Culture Cognitive & emotional development Social network, influences, family, environment What is acceptable? Desirable? Affordable? Can they use it, will they use it, will it motivate them, what’s the hook (points of engagement)

Your case study
• Surprises about your ‘customers’ that impact delivery, messaging, technology, displays, data representation…. • (what kids will wear, what they want to hear) eMOTE
(Enhanced Minority health Outcomes Through Entertainment)

How do you get into shoes of the ‘customer’ to develop systems that best ‘fit’ the customer?
• • • • • • • Community Based Participatory Research (CBPR) Systems Science: Group Model Building (GMB) Playtesting Idea building groups Focus groups Nominal group techniques Walkthroughs

Recognizes the community has it own identity Builds on strengths & resources within the community Facilitates collaborative coalition Promotes capacity building (everyone collects data) Emphasizes local relevance of public health problems Recognize and attend to the multiple ‘levers’ of health and disease • Involves systems development through iterative processes • Disseminates findings and knowledge gained to all partners and all partners will be involved in the dissemination process • Involves a long-term process and commitment • • • • • •

Which Groups Come to the Table?

Which Issues Get to the Table?

Birds-eye view of CBPR
• Select the community
– “unit of identity”

• Select your initial partners – individuals, representatives of organizations or both • True dialogue with partners (and others that should be at the table) before the proposal is written and throughout the process • Identification of WHAT, HOW, WHO, WHEN
– – – – WHAT – research question HOW – research design WHO – who is responsible for what? WHEN - timeline

• Sustainability plans from the beginning

From Systems Science: Group Model Building
• A form of group decision support, involving a group of stakeholders with a complex problem
– Group facilitation – Model building and refinement in public – Simulation of scenarios and options – Extensive facilitated discussion and analysis – Facilitated policy design and decisions

Nuts and Bolts
• Management team (10-20) with a Modeling/Facilitation team (2-4) • Four full days over 3-to-4 months • Extensive between meeting work • Rapid prototyping of model with finished simulation product • Facilitation of implementation plans

Group Model Building (GMB)
• “Group model building is a process in which team members exchange their perceptions of a problem and explore such questions as: what exactly is the problem we face? How did the problematic situation originate? What might be its underlying causes? How can the problem be tackled?” (Vennix 1996, p. 3) • “Group model building, as we intend the phrase, signals the intent to involve a relatively large client group in the business of model formulation, not just conceptualization” (Richardson and Andersen, 1995, p. 1)

Why would one want to involve a large number of people in the modeling process?
Hovmand & White ISSH 2011 Pittsburgh 22

Reasons for using GMB
• Insights come from modeling process • Likelihood of implementation • Participation as an intervention
– Social construction of new realities – Models are only artifacts of that process – Changes in mental models of participants

• “Dignity of risk”
– People should have the opportunity to be involved in designing the systems that are intended to benefit them

• Theory building
– Grounded theory, synthesis of existing theories from experts

• Information source
– Structure, dynamics, nonlinear relationships, parameters, policies and interventions
Hovmand & White ISSH 2011 Pittsburgh 23

West End Neighborhood, St. Louis, MO Residents and community leaders from West End Neighborhood work with researchers and staff from Washington University and Transtria LLC to build a model to understand social determinants of childhood obesity and plan new programs and services.

Hovmand & White

ISSH 2011 Pittsburgh


Example from a causal mapping exercise focusing neighborhood safety
Churches coming together Neighborhood schools + + Neighborhood pride + Crime + + Vacant houses and buildings Gangs using park + Condition of buildings Jobs Maintain home + Parents can't control kids Street cleaning + City maintaining parks Educational system Tearing down houses Educational background + Meaningful employment + Kids not having fathers in home Connecting to parks outside community Policeman on foot patrol Police not responding Community acitivties Getting loans to improve homes Finding dope + + Police + Police searches

Playing soccer

Sports teams using park -

Getting sports teams together

Kick ball team

+ Gangs Not disciplining kids Condition of parks Rusting chains+


Cancelling program

High dropout rate

Time on hands, nothing to do

How do you get into shoes of the ‘customer’ to develop systems that best ‘fit’ the customer?
• • • • • • • Community Based Participatory Research (CBPR) Systems Science: Group Model Building (GMB) Focus groups Playtesting Idea building groups Nominal group techniques Walkthroughs

Focus Groups: The Basics…..
• Facilitated (trained moderator) Group Discussion • 8 to 12 homogenous members, who don’t know each other • Audience segmented by level of “use”/”exposure”/demographics • Rely heavily on open-ended questions and reflections • Participants usually paid & fed, sometimes transported • Process is audio- or video-taped (with consent) • Heavily influenced by group interaction • Minimum of 2-4 groups per “segment”

Development Process
• Fact Finding • Review Existing Materials, Literature Review • Identify Possible Audience Segments (SOC, SES strata) • Interview Opinion Leaders (Primary Data) • Convene Expert and Lay Advisory/Review Groups Exploratory Focus Groups (Primary Data) • Individual Interviews Develop FIRST WHACK • Review by expert and lay groups Pre-Test • Review and Revise Pilot Test: Expose participants under trial conditions/obtain feedback • Revise Implement: Evaluate Efficacy/Effectiveness • Post-implementation interviews/Focus groups • Stratify by participant’s level of change

• • • • •

Exploratory Focus Groups
• Explore target audience experiences, thoughts, feelings, attitudes, fears, conflicts, pros and cons regarding the behavior or issue • Approach audience with blank canvas • Theory-driven Moderator Outlines • Purposeful sampling

How do you get into shoes of the ‘customer’ to develop systems that best ‘fit’ the customer?
• • • • • • • Community Based Participatory Research (CBPR) Systems Science: Group Model Building (GMB) Focus groups Playtesting Idea building groups Nominal group techniques Walkthroughs

How do you use the knowledge that you get from all this?
• This may seem obvious…. But it isn’t • How will you analyze the data?
– Lay out software, mixed models, impact of one set of interviews/playtesting sessions/ etc. on the next iteration of (game narrative, look, layout, sensor set, user interface, data display, what else?)

• How will you incorporate your findings?
– Lay out feedback and iteration plans

Incorporating Findings
• Case study – from the simple to the sublime

And now for something completely different!
• Dave Gustafson!

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