PublicationsFull publication list
Bursting the Information Bubble: Identifying Opportunities for Pediatric Patient-Centered Technology
Andrew D. Miller, Ari H. Pollack, Wanda Pratt. Bursting the Information Bubble: Identifying Opportunities for Pediatric Patient-Centered Technology, AMIA Annual Symposium Proceedings. Vol. 2016. (To appear)PDF | Abstract
Although hospital care is carefully documented and that information is electronically available to clinicians, few information systems exist for patients and their families to use while they are in the hospital. Information often appears trapped within the hospital room. In this paper, we present findings from three participatory design sessions that we conducted with former patients, their parents, and clinicians from a large children’s hospital. Participants discussed challenges they faced getting information while in the hospital, and then designed possible technological solutions. Participants designed technologies aimed at extending parents’ access to and involvement in patients’ care. Their designs showed opportunities for health informatics within and beyond the children’s hospital room: to allow parents and children to disseminate information from within, access information from the hospital room remotely, establish pervasive and collaborative communication with the clinical care team, and learn about their child’s care throughout the hospital stay.
PD-atricians: Leveraging Physicians and Participatory Design to Develop Novel Clinical Information Tools
Ari H Pollack, Andrew Miller, Sonali R. Mishra, Wanda Pratt. PD-atricians: Leveraging Physicians and Participatory Design to Develop Novel Clinical Information Tools, AMIA Annual Symposium Proceedings. Vol. 2016. (To appear)PDF | Abstract
Participatory design, a method by which system users and stakeholders meaningfully contribute to the development of a new process or technology, has great potential to revolutionize healthcare technology, yet has seen limited adoption. We conducted a design session with eleven physicians working to create a novel clinical information tool utilizing participatory design methods. During the two-hour session, the physicians quickly engaged in the process and generated a large quantity of information, informing the design of a future tool. By utilizing facilitators experienced in design methodology, with detailed domain expertise, and well integrated into the healthcare organization, the participatory design session engaged a group of users who are often disenfranchised with existing processes as well as health information technology in general. We provide insight into why participatory design works with clinicians and provide guiding principles for how to implement these methods in healthcare organizations interested in advancing health information technology.
Closing the Gap: Supporting Patients’ Transition to Self-Management after Hospitalization
Ari H. Pollack, Uba Backonja, Andrew D. Miller, Sonali Mishra, Maher Khelifi, Logan Kendall, Wanda Pratt. Closing the Gap: Supporting Patients’ Transition to Self-Management after Hospitalization, Proceedings of CHI ’16, San Jose, CA, May 7-12, 2016.PDF | Abstract
Patients going home after a hospitalization face many challenges. This transition period exposes patients to unnecessary risks related to inadequate preparation prior to leaving the hospital, potentially leading to errors and patient harm. Although patients engaging in self-management have better health outcomes and increased self-efficacy, little is known about the processes in place to support and develop these skills for patients leaving the hospital. Through qualitative interviews and observations of 28 patients during and after their hospitalizations, we explore the challenges they face transitioning from hospital care to self-management. We identify three key elements in this process: knowledge, resources, and self-efficacy. We describe how both system and individual factors contribute to breakdowns leading to ineffective patient management. This work expands our understanding of the unique challenges faced by patients during this difficult transition and uncovers important design opportunities for supporting crucial yet unmet patient needs.
'Not Just a Receiver': Understanding Patient Behavior in the Hospital Environment
Sonali R. Mishra, Shefali Haldar, Ari H. Pollack, Logan Kendall, Andrew D Miller, Wanda Pratt. 'Not Just a Receiver': Understanding Patient Behavior in the Hospital Environment, Proceedings of CHI ’16, San Jose, CA, May 7-12, 2016.PDF | Abstract
Patient engagement leads to better health outcomes and experiences of health care. However, existing patient engagement systems in the hospital environment focus on the passive receipt of information by patients rather than the active contribution of the patient or caregiver as a partner in their care. Through interviews with hospitalized patients and their caregivers, we identify ways that patients and caregivers actively participate in their care. We describe the different roles patients and caregivers assume in interacting with their hospital care team. We then discuss how systems designed to support patient engagement in the hospital setting can promote active participation and help patients achieve better outcomes.
Partners in Care: Design Considerations for Caregivers and Patients During a Hospital Stay
Andrew D. Miller, Sonali R. Mishra, Logan Kendall, Shefali Haldar, Ari H. Pollack, Wanda Pratt. Partners in Care: Design Considerations for Caregivers and Patients During a Hospital Stay, Proceedings of CSCW ’16, San Francisco, CA, February 27-March 2, 2016.PDF | Abstract
Informal caregivers, such as close friends and family, play an important role in a hospital patient's care. Although CSCW researchers have shown the potential for social computing technologies to help patients and their caregivers manage chronic conditions and support health behavior change, few studies focus on caregivers' role during a multi-day hospital stay. To explore this space, we conducted an interview and observation study of patients and caregivers in the inpatient setting. In this paper, we describe how caregivers and patients coordinate and collaborate to manage patients' care and wellbeing during a hospital stay. We define and describe five roles caregivers adopt: companion, assistant, representative, navigator, and planner, and show how patients and caregivers negotiate these roles and responsibilities throughout a hospital stay. Finally, we identify key design considerations for technology to support patients and caregivers during a hospital stay.
No Longer Wearing: Investigating the Abandonment of Personal Health-Tracking Technologies on Craigslist
James Clawson, Jessica A. Pater, Andrew D. Miller, Elizabeth D. Mynatt, Lena Mamykina. No Longer Wearing: Investigating the Abandonment of Personal Health-Tracking Technologies on Craigslist, Proceedings of Ubicomp ’15, Osaka, Japan, September 07-11, 2015.PDF | Abstract
Personal health-tracking technologies have become a part of mainstream culture. Their growing popularity and widespread adoption present an opportunity for the design of new interventions to improve wellness and health. However, there is an increasing concern that these technologies are failing to inspire long-term adoption. In order to understand why users abandon personal health-tracking technologies, we analyzed advertisements of secondary sales of such technologies on Craigslist. We conducted iterative inductive and deductive analyses of approximately 1600 advertisements of personal health-tracking technologies posted over the course of one month across the US. We identify health motivations and rationales for abandonment and present a set of design implications. We call for improved theories that help translate between existing theories designed to explain psychological effects of health behavior change and the technologies that help people make those changes.
This Digital Life: A Neighborhood-based Study of Adolescents’ Lives Online
Pater, J.A., Miller, A.D., Mynatt, E.D. This Digital Life: A Neighborhood-based Study of Adolescents’ Lives Online, Proceedings of the ACM Conference on Human Factors in Computing Systems (CHI 2015). Seoul, Korea. April 18-23, 2015.PDF | Abstract
In this paper, we present the results of a multi-year study of the social computing practices of 179 adolescents (Mage=12.4 years, SD=1.3; range: 10-14) living in a majority-minority lower-income urban neighborhood in the Southeast U.S. We investigate shifting social media practices using annual surveys and focus groups. We describe participants’ social media use and motivations and show how that use has shifted over time. We show how participants identify social pressures and influences as well as specific behaviors including computer-mediated risky behaviors and self-harm. We discuss the implications of our findings for the CHI research community, including methodological challenges and the need for further study of computer-mediated harmful behaviors in youth populations. By demonstrating how large-scale trends are enacted on the ground, we describe participants’ uses, motivations and behaviors as they deal with the increasing influence of technology in their social lives.
Social Tools for Everyday Adolescent Health (dissertation)
Andrew D Miller. Social tools for everyday adolescent health. Georgia Institute of Technology; 2014.PDF | Abstract
Everyday health and fitness research in HCI has generally focused on social comparison and "gamified" competition. This is especially true in studies focused on adolescents and teens. However, both theory from social psychology and evidence from the health promotion community suggest that these direct egocentric models of behavior change may be limited in scope: they may only work for certain kinds of people, and their effects may be short-lived once the competitive framework is removed. I see an opportunity for a different approach: social tools for everyday adolescent health. These systems, embedded in existing school and community practices, can leverage scalable, non-competitive social interaction to catalyze positive perceptions of physical activity and social support for fitness, while remaining grounded in the local environment.
In this dissertation, I report findings based on a series of participatory design-based formative explorations; the iterative design of a pedometer-based pervasive health system to test these theories in practice; and the deployment of this system—StepStream—in three configurations: a prototype deployment, a 'self-tracking' deployment, and a 'social' deployment. In this dissertation, I test the following thesis: A school-based social fitness approach to everyday adolescent health can positively influence offline health behaviors in real-world settings. Furthermore, a noncompetitive social fitness system can perform comparably in attitude and behavior change to more competitive or direct-comparison systems, especially for those most in need of behavior change.
I make the following contributions: (1) The identification of tensions and priorities for the design of everyday health systems for adolescents; (2) A design overview of StepStream, a social tool for everyday adolescent health; (3) A description of StepStream's deployment from a socio-technical perspective, describing the intervention as a school-based pervasive computing system; (4) An empirical study of a noncompetitive awareness system for physical activity; (5) A comparison of this system in two configurations in two different middle schools; (6) An analysis of observational learning and collective efficacy in a pervasive health system.
StepStream: A School-based Pervasive Social Fitness System for Everyday Adolescent Health
Miller, A.D., Mynatt, E.D. StepStream: A School-based Pervasive Social Fitness System for Everyday Adolescent Health, Proceedings of the ACM Conference on Human Factors in Computing Systems (CHI 2014). Toronto, Canada. April 26-May 1, 2014.PDF | Abstract
Computer-supported fitness interventions for adolescents have the potential to improve adolescents’ attitudes and perceptions about physical activity through peer influence and interpersonal accountability. Past research has explored the potential of interventions based on competition and social-comparison mechanisms. We present a new approach: school-based, pervasive social fitness systems. We describe one such system: StepStream, a pedometer-based microblog we designed and deployed for four weeks with 42 US middle school students. StepStream users improved their attitudes about fitness and increased their sense of social support for fitness. The least-active students also increased their daily activity. We show that our school-based social fitness approach performed comparably in attitude and behavior change to more competitive or direct-comparison systems. These results expand the strategies available computer-supported fitness interventions. Our school-based social fitness approach to everyday adolescent health shows the potential for social computing systems to positively influence offline health behaviors in real-world settings.
Peer Influence in a Self-Tracking Pervasive Fitness System for Adolescents: A Comparison Study
Miller, A.D., Mynatt, E.D. Peer Influence in a Self-Tracking Pervasive Fitness System for Adolescents: A Comparison Study. Presented at the Workshop on Interactive Systems in Healthcare at AMIA 2014, Washington, DC, November 15th, 2014.PDF | Abstract
We describe findings from a deployment of a self-tracking pervasive fitness system for adolescents, and contrast it to a social version of the same system (StepStream). Overall, students in this study did not improve their attitudes about health and fitness, and there was no overall increase in daily physical activity. We provide evidence for two contributing factors: the specific social structure of the participant group, and the persuasive design of the system. Our results show that even a group with strong social ties will not necessarily leverage those connections for fitness without encouragement from the system. This study also provides evidence that attitude and behavior change seen in other deployments (especially the ‘social’ version of StepStream) are also due to these factors, and not merely the result of novelty effects or researcher bias.
Design Strategies for Youth-Focused Pervasive Social Health Games
(Winner, Best Student Paper Award)
Miller, A.D., Pater, J.A., Mynatt, E.D. Design Strategies for Youth-Focused Pervasive Social Health Games, 7th International Conference on Pervasive Computing Technologies for Healthcare (PervasiveHealth 2013),5-8 May 2013PDF | Abstract
Adolescent obesity is an increasing challenge, and pervasive social health games hold much promise for promoting sustained healthy behaviors. Researchers and designers of these systems have many potential theories and existing best practices at their disposal. Our study, grounded in participatory design, shows which ones matter—both for pervasive social health games and within the cultural context of a community we studied over the course of three years. We worked with 112 US middle school students from a lower-income community in a series of participatory design exercises focused on social rewards for everyday physical activity. In our analysis, we discuss design implications in four key areas: social presence, gender effects, incentives and competition. We show how these themes manifested in students’ designs and why they were particularly important to our participants. We then use our findings to suggest design strategies for youth-focused pervasive social health games.
Designing for Spectators and Coaches: Social Support in Pervasive Health Games for Youth
Poole, E. S. , Eiriksdottir, E., Miller, A.D., Xu, Y., Catrambone, R., Mynatt, E.D. Designing for Spectators and Coaches: Social Support in Pervasive Health Games for Youth, 7th International Conference on Pervasive Computing Technologies for Healthcare (PervasiveHealth 2013), 5-8 May 201PDF | Abstract
Active video games and other technology-based interventions can promote physical activity participation in children and adolescents, particularly those who are uninterested in traditional sports or lack access to gyms, sports clubs, or safe neighborhood recreational environments. Yet simply placing a game console in a home or school might not be sufficient for changing physical activity behaviors. Rather, social support and opportunities for structured group activity may be important aspects of pervasive health games. We know little, however, about how to design active video games and other technology- based interventions in ways that explicitly allow for the provision of social support by other players as well as “spectators” of the game. Based on the results of a longitudinal study of an active video game used in American schools, this paper contributes design recommendations for features in pervasive health games that explicitly encourage social support.
The work of play: supporting a pervasive health behavior change intervention for US middle school students
Miller, A. D., Poole, E., Xu, Y., Eiriksdottir, E., Kestranek, D., Catrambone, R., & Mynatt, E. (2012). The work of play: supporting a pervasive health behavior change intervention for us middle school students. CSCW '12: Proceedings of the ACM 2012 conference on Computer Supported Cooperative Work.PDF | Abstract
Technology-based health behavior change interventions involving passive on-body sensing and feedback interfaces show promise for increasing participation in physical activity. However, the majority of prior studies are small-scale interventions that heavily rely on research teams for programmatic support. In larger-scale deployments, participants may have to take over setup and maintenance tasks. In this paper, we examine the “hidden work” involved with the large-scale deployment of a behavior change application in American schools. We offer insight into the coordination required to maintain such deployments, and identify unique challenges that arise when schoolchildren are the target of a behavior change intervention. Our findings highlight the behind-the-scenes coordination and management work required of adult facilitators in order to support pervasive health interventions for children in school environments. We offer advice to researchers and project managers attempting integration of technology-based health behavior change applications for children.
Designing pervasive health games for sustainability, adaptability and sociability
Xu, Y., Poole, E.S., Miller, A.D., Eiriksdottir, E., Catrambone, R., Mynatt, E.D. “Designing pervasive health games for sustainability, adaptability and sociability,” Proceedings of the International Conference on the Foundations of Digital Games (FDG '12).PDF | Abstract
Active video games (AVG) have become widespread as more physical interfaces are introduced in video games. Lab based studies have indicated that AVGs can increase the amount and intensity of physical activity compared to non-active games and TV, however, the long-term effectiveness of AVGs has yet been established. In fact, most of the existing studies show a reduction of interest and participation over time. This paper presents our findings from a long-term, multi-site deployment of a pervasive health game, the American Horsepower Challenge (AHPC). Similar to previous studies, our findings also show reduced effectiveness of the game, but on a much larger scale. Moreover, we analyze reasons for this and report what kind of game related online and offline activities happened during the deployment. We argue that a shift of evaluation metrics and design goals is required to make real-world sustainable behavior changes. Based on empirical data, we propose three goals for AVGs—sustainability, adaptability and sociability. Behavior-changing games can learn how to achieve these goals from existing game genres, such as alternate reality games, location-based games, family games, and multiplayer online games etc.
This is not a one-horse race: understanding player types in multiplayer pervasive health games for youth
Xu, Y., Poole, E. S., Miller, A. D., Eiriksdottir, E., Kestranek, D., Catrambone, R., & Mynatt, E. D. (2012). This is not a one-horse race: understanding player types in multiplayer pervasive health games for youth. Presented at the CSCW '12: Proceedings of the ACM 2012 conference on Computer Supported Cooperative Work.PDF | Abstract
Technology-based interventions for promoting health behavior-change frequently leverage multiplayer game mechanics such as group-based competitions. However, health interventions successful for groups writ large may not always translate to successful behavior change at the individual level. In this paper, we explore the tension between group and individual success, based on an empirical study on a long-term real-world deployment of a pervasive health game for youth. We report five distinctive player types along the dimensions of motivation, behavior, and influence on others. Based on the findings, we provide design suggestions to help game designers integrate group mechanisms that maximize intervention effectiveness.
The Place for Ubiquitous Computing in Schools: Lessons Learned from a School-Based Intervention for Youth Physical Activity
Poole, E. S., Miller, A. D., Xu, Y., Eiriksdottir, E., Catrambone, R., & Mynatt, E. D. (2011). The Place for Ubiquitous Computing in Schools: Lessons Learned from a School-Based Intervention for Youth Physical Activity. Proceedings of the 13th ACM international conference on Ubiquitous Computing - Ubicomp '11, 395–404.PDF | Abstract
With rising concerns about obesity and sedentary lifestyles in youth, there has been an increasing interest in understanding how pervasive and ubiquitous computing technologies can catalyze positive health behaviors in children and teens. School-based interventions seem like a natural choice, and ubiquitous computing technologies hold much promise for these interventions. Yet the literature contains little guidance for how to approach school-based ubicomp deployments. Grounded in our analysis of a large- scale US school-based intervention for promoting youth physical activity, we present an approach to the design and evaluation of school-based ubicomp that treats the school as a social institution. We show how the school regulates students’ daily lives, drawing from work in the sociology of schools to create a framing for planning, executing and analyzing school-based ubicomp deployments. These insights will assist other researchers and designers engaging in deployments of ubiquitous computing systems in settings with established institutional structures.
Examining the Impact of Collaborative Tagging on Sensemaking in Nutrition Management
Lena Mamykina, Andrew D. Miller, Catherine Grevet, Yevgeniy Medynskiy, Michael A. Terry, Elizabeth D. Mynatt, and Patricia R. Davidson. 2011. Examining the impact of collaborative tagging on sensemaking in nutrition management. In Proceedings of the 2011 annual conference on Human factors in computing systems (CHI ’11).PDF | Abstract
Collaborative tagging mechanisms are integral to social computing applications in a variety of domains. Their expected benefits include simplified retrieval of digital content, as well as enhanced ability of a community to makes sense of the shared content. We examine the impact of collaborative tagging in context of nutrition management. In a controlled experiment we asked individuals to assess the nutritional value of meals based on photographic images and observed the impact of different types of tags and tagging mechanisms on individuals nutritional sensemaking. The results of the study show that tags enhance individuals’ ability to remember the viewed meals. However, we found that some types of tags can be detrimental to sensemaking, rather than supporting it. These findings stress the importance of tagging vocabularies and suggest a need for expert moderation of community sensemaking.
Stepping Outside the Classroom: Fitness Video Games for K-12 Settings
Eiriksdottir, E., Kestranek, D., Miller, A.D., et al. Stepping Outside the Classroom: Fitness Video Games For K-12 Settings. Presented at the Workshop on Interactive Systems in Healthcare at the 28th international conference on Human factors in Computing Systems – CHI ’10, Atlanta, GA, 2010.PDF | Abstract
We discuss the development and ongoing evaluation of The American Horsepower Challenge, a pedometer- based fitness game for middle school students that is being used in over 60 schools across the United States.
Constructing Identities through Storytelling in Diabetes Management
Lena Mamykina, A.D. Miller, Elizabeth D. Mynatt et al. (2010) Constructing Identities through Storytelling in Diabetes Management. In Proceedings of the 28th international conference on Human factors in computing systems – CHI ’10.PDF | Abstract
The continuing epidemics of diabetes and obesity create much need for information technologies that can help individuals engage in proactive health management. Yet many of these technologies focus on such pragmatic issues as collecting and presenting health information and modifying individuals’ behavior. We argue that viewing health management from an identity construction perspective opens new opportunities for research and design in technologies for health.
Temporal Data in a Health Self-Management Application
Medynskiy, Y., Miller, A., Yoo, J.W., Mynatt, E. Temporal Data in a Health Self-Management Application. Presented at the Interacting with Temporal Data workshop at CHI 2009.PDF | Abstract
In this position paper, we present our initial work in designing and developing Salud!, a web-based platform for supporting health self-management. Salud! will allow its users to track personally-relevant aspects of their everyday life, and provide visualization and analytics tools with which to make sense of the resulting datasets.
Give and Take: A study of photosharing theory and practice
Miller, A. and Edwards, W. Give and Take: A Study of Consumer Photo-Sharing Culture and Practice. Proceedings of the SIGCHI conference on Human factors in computing systems, ACM (2007), 356.PDF | Abstract
In this paper, we present initial findings from the study of a digital photo-sharing website: Flickr.com. In particular, we argue that Flickr.com appears to support—for some people—a different set of photography practices, socialization styles, and perspectives on privacy that are unlike those described in previous research on consumer and amateur photographers.