Probing For Information Keith Cheverst, Karen Clarke, Guy Dewsbury and Mark Rouncefield Department of Computing, SECAMS Building, Lancaster University, Lancaster LA1 4YR United Kingdom. +44 (0)1524 59 3097
[email protected]
Andy Crabtree, Terry Hemmings and Tom Rodden The School of Computer Science and IT The University of Nottingham, Jubilee Campus, Wollaton Road Nottingham NG8 1BB, UK. +44 (0)115 84 66512
[email protected] ABSTRACT
The movement of digital technologies out of the workplace brings with it the need to develop new techniques to consider how technology might relate to and support everyday activities in a wide variety of different contexts. In our own case, our user groups consist of former psychiatric patients and disabled people living in residential care settings. Methods for identifying user needs in care settings are not well developed and the situation presents a very complex set of design challenges. In particular, the highly personal and sensitive character of such settings presents conventional observational techniques, such as ethnography, with obdurate problems that make direct observation intrusive, disruptive and inappropriate on many occasions. Direct observation requires supplementation in such settings. Accordingly, we report on our experiences of adapting Cultural Probes to open up communication channels and foster an ongoing dialogue with the members of our user groups in order to generate key insights into their unique needs. Keywords
Ethnography; User Studies and Fieldwork; Healthcare; Home; Disability Access; Empirical Methods, Qualitative. INTRODUCTION
This paper reports on the methods adopted, adapted and devised in a large interdisciplinary research project in the UK that is concerned to inform the development of ‘enabling technologies’ to assist persons situated in residential care settings. A primary objective of the project is to improve the quality of everyday life in care settings by building and adapting technologies for a range of user groups and application domains. Meeting this objective requires us to address fundamental long-term research challenges, particularly how computing concepts and technologies might be related and applied to residential COPYRIGHT NOTICE.
care? Assistive and smart home technology has been shown to enable people to lead a better quality of life and augment the care process and appropriate use of this technology can demonstrably improve quality of life [2, 3]. However, such technologies have not been taken up to any great extent and many people do not receive appropriate support Consequently, there is little evidence of usability approaches and guidelines that facilitate the matching of technology to user needs [5]. In the absence of an established design literature in this area, our approach was and is concerned to pay the commonplace activities of daily life in residential care settings the attention usually accorded extraordinary events [6]. In order to achieve this, we decided to approach the study of disability and mental impairment by considering how affected parties and their carers (or members) practically perceive and understand these issues and how they practically affect their everyday lives, rather than in theoretical terms of explanatory models (which abound in the social sciences). In adopting this position, we are suggesting that when considering technological intervention in the lives of the disabled and mentally impaired what is needed is a position which enables designers to understand these sensitive matters ‘from within’, attending to the members’ perspectives and replacing political rhetoric with concrete recommendations for design. It soon transpired that developing an understanding of disability and mental impairment from within would not be a straightforward matter, however. Residential environments of whatever sort are much more personal spaces than workplaces and persons are not always so willing to have ethnographers pry into their lives, and especially their disabilities and impairments. Indeed, where psychiatric matters are concerned, the presence of an ethnographer kitted out with standard research tools - tape recorders, videos, and notebooks - may not only be disconcerting but damaging, triggering detrimental episodes. It was obvious, then, that we would have to devise some other means of understanding the lives of the
members our user groups; some way of supplementing our understanding that was not so intrusive and potentially disruptive. Below we consider the adoption and use of Cultural Probes [7], which we combined with standard ethnography wherever possible to provide the design team with rich insights into the unique needs of the members of user groups. SENSITIVE SETTINGS & CULTURAL PROBES
The settings for our project include a residential hostel for former psychiatric patients and a stroke victim and her family, each of which we report on here. The hostel is the first step for patients leaving the psychiatric wards of local hospitals that are currently being closed down. In the hostel, residents are provided with a room and are monitored by staff. Residents may then move on to another, semi-independent, living site of sheltered housing consisting of a number of flats and bed-sits, prior to moving out to flats in the local area. Alternately, if they are deemed to need further and continuing support, residents may move back to the hostel. The overall aim of these facilities is to develop independent living skills, to gradually introduce the patients back into the community and to allow them to support themselves. As a general, and important, principle any technology introduced into the setting should contribute to this goal in some way. A technology that merely completes a task for residents does little in promoting their independence but merely shifts reliance onto the technology. The stroke victim - Dorothy - lives at home. Since strokes can have potentially devastating effects, mediated by age, financial circumstances, living environment, family support, social position and a host of contingencies, the care setting is an important consideration when studying the everyday lives of the disabled and their carers. The majority of people with physical disabilities and learning difficulties live in their own home or with family members. The impact of disabilities on peoples’ lives extends beyond the sufferer to include family members, friends and neighbors who provide informal care. These informal carers face the challenge of coping with the social, intellectual, emotional and physical demands of day-to-day support. The kinds of the research questions we are concerned with when considering technical support include general questions about the organization and coordination of domestic space as well as more specific issues to do with the availability and use of existing technologies and their affordances. We have been interested in how users organize their day, the kinds of things they do and how they go about doing them, their use of technology, the organization of their personal space and so on. One way in which we have attempted to increase the repertoire of available techniques is through the adoption and adaptation of Cultural Probes, and for the reasons outlined above.
Cultural Probes originated in the traditions of artist– designers and have been deployed in a number of innovative design projects to provide inspirational materials for design activity. By way of contrast, we use Cultural Probes - cameras, diaries, maps, dictaphones, photo-albums, postcards etc. - as a way of eliciting information from the members of user groups that are difficult to research by other means and as a way of uncovering or at least shedding light on users social, emotional, and aesthetic values and habits. The probes also provide an engaging and effective way to open up communication channels and foster an ongoing dialogue with users involving them in the design process. This paper documents how our adaptation of Cultural Probes has provided a fruitful means of eliciting information about sensitive design settings and the needs of users therein. The probes have enabled us to overcome some of the distance that inevitably exists between researchers and users and, thereby, to gather a rich set of materials that grounds designs in the lived realities and textures of everyday life in some rather unconventional residential settings. Cultural probes are one way in which we can attempt to meet what Edwards and Grinter [4] regard as a major challenge for designers: … to pay heed to the stable and compelling routines of the home, rather than external factors, including the abilities of the technology itself. These routines are subtle, complex, and ill-articulated, if they are articulated at all ... Only by grounding our designs in such realities of the home will we have a better chance to minimize, or at least predict, the effects of our technologies. Cultural Probes have gained some prominence as a means of inspiring interactive systems design in domestic settings. The approach is concerned to address what role technology might play in the home of the future and, specifically, how it can support the domestic values that motivate the adoption and use of technology. Gaver argues that domestic values are very different from those operating in the workplace and that as a consequence design requires different methods to understand the unique needs of residents situated in domestic settings. There is a danger that as technology moves from the office into our homes, it will bring along with it workplace values such as efficiency and productivity at the expense of other possibilities. [8] These “other possibilities” are characterized as ludic pursuits - a notion that is intended to convey and provided an orientation to the playful character of domestic life. By invoking playfulness in contrast to production and efficiency as a basic orientation to understanding interaction in the home, Gaver is not simply suggesting that we attend to whatever passes as entertainment. The
implications of playfulness are far more subtle and should direct our attention to the highly personal and diverse ways in which people “explore, wonder, love, worship, and waste time” together and in other ways engage in activities that are “meaningful and valuable” to them (ibid.). This emphasis on diversity and the personal betrays the influence of the conceptual arts on the design and use of Cultural Probes, particular the Situationist and Surrealist schools of thought. The conceptual arts are drawn upon to inform the development of probe artefacts that provoke and so hopefully reveal the motivational forces that shape an individual’s home life. No doubt the artistic underpins the anti-scientific stance that many find appealing about the probes approach. Probes are about understanding people in situ, uniquely not abstractly en masse, and the results of the probe exercise are highly individual, emotive, and idiosyncratic. As Gaver puts it, domestic probes
routine daily home life on digital video. Family histories and biographical background material was provided in the way of photograph albums and informal interviews. Copies of medical records and documents were also provided, all of which served to enrich the detail and scope of the information gathered. Accordingly, we were informed as to which rooms were used most often, person’s favorite activities (or activities they would like to do or missed being able to perform); and, particularly, the various kinds of technology employed by members in the home, no matter how mundane. The issues raised by an exploration of the role of the domestic environment as a technological environment resonate with many of HCI’s longstanding concerns; particularly matters to do with the social organization or orderly character of the application domain that have been identified as key to opening design issues in this area [12, 13].
… offer fragmentary glimpses into the rich texture of people’s home lives. They allow us to build semi-factual narratives, from which design proposals emerge like props for a film. [10] From Inspiration to Information
Sensitivity to the feelings of the participants who agreed to be part of our study involved the choice a range of sympathetic data gathering techniques. Some agreed to keep personal diaries of their daily activities. All were also supplied with polaroid cameras and voice activated dictaphones in a Cultural Probe pack. In addition to these items, the packs consisted of a disposable camera, photo album, visitors book, scrapbook, post-it notes, pens, pencils and crayons, a set of postcards addressed to the researcher, and a map. These were handed out, much like a birthday or Christmas present, and the use of the probes was explained. The probe packs also contained a set of instructions. The instructions said: These items are Cultural Probes - but don't worry they're just a way for us to find out more about you, your everyday life, what you think and feel. We'd like you to use them to tell us about yourself - and below are a few ideas you might want to think about. Ignore these if you like - nothing is compulsory - do as much or as little as you like. We hope its fun. I'll come back to collect them in about a week Further instructions included some suggestions as to how the various devices might be used: Draw on the maps, use post-it notes - indicate where you feel safe or threatened - favorite places - places you avoid Or:
Figure 1. Informational Probes Pack Our probes, whilst apparently performing many of the same functions as Gaver’s - photos, postcards, comments etc - were then very different. Not only were they less obviously ‘designed’ or artistic in character, consisting of readily available commercial devices with relatively mundane instructions (no concern with lucid dreams here), they were intended primarily as an informational input for design. For Gaver, and the Presence project, Cultural Probes were a device for inspiring design. The cultural probes were successful for us in trying to familiarize ourselves with the sites in a way that would be appropriate. They provided us with a rich and varied set of materials that both inspired our designs and let us ground them in the detailed textures of the local cultures. [9]
The diary can be used to record your daily events and actions as well as visitors that you get everyday. You can write in it whatever you like or wish to tell the team.
For us, while inspiration would undoubtedly be an added bonus, our prime concern
The stroke victim and her husband also allowed a researcher to conduct ethnography and record parts of the
was to gather information into how the members of our user groups lived their lives, their everyday circumstances,
routines and rhythms, their practical concerns, everyday aesthetics, and so on. The use of Cultural Probes to provide insight into resident’s everyday activities and concerns became one way of identifying and ultimately addressing some of the moral and ethical components of the design enterprise in sensitive settings. One particular concern in these care settings is to think carefully through the complex issues of empowerment and dependence, whilst providing support for individuals in various ways.
takes. In practical terms this means her body signs must be closely checked three times daily in order that future dosages of drugs can be calculated. In short, in the light of Dorothy’s past condition, decisions regarding the amounts of each drug that make up the ingredients of her medicinal cocktail - some 30 plus doses of 8 to 10 different drugs, see Figure 2 - must be made throughout the day and monitoring this is an abiding everyday concern, which family members keep in check in organized ways through the use of a medication chart (Figure 3).
Figure 2. Dorothy’s Medication THE EMERGENCE OF ABIDING CONCERNS
Our ethnographic studies and Informational Probes have indicated some major preoccupations or abiding concerns that occur across the different care settings we are studying, such as a preoccupation with safety and security. At the hostel, for example, residents have been subjected to frequent physical and verbal attacks. This has resulted in the gates being locked at four o’clock each day - when the school day ends - and some residents will only travel outside the hostel by taxi. Consequently residents are increasingly cut-off from the outside community and their friends. A concern with safety and security outside the home is also reflected in diary entries of elderly people we have started to involve in our studies and is manifest in reduced social contact. These unfortunate circumstances pose fascinating, if distressing, problems for the design of domestic technologies, highlighting the importance of connections between the home environment and the outside world. Illness and medication appears as another abiding interest. It is quite common amongst people with strokes for them to have other illness and attendant medical problems. In Dorothy’s case she has, amongst other things, late onset diabetes, this complicates matters as far as her dietary and medical needs are concerned. The drugs prescribed to treat both her stroke and diabetes are, to certain degrees, mutually antagonistic and require constant monitoring. Her diet, meal times and exercise must be planned and monitored closely as together they not only affect her glucose levels and insulin intake but also have some bearing on the efficacy of some of the other drugs she
Figure 3. Dorothy’s Medication Chart In the hostel, medication issues are similarly a focus of much concern. The medication regime plays a central role in the maintenance of normal everyday life for many persons suffering from psychiatric conditions. Many of the residents are on daily medication regimes and expressed their concerns about the consequences of forgetting to take their medication. In the semi-independent living area residents are expected to manage their own medication and weekly supplies are provided by the pharmacy, packaged into individual doses within a plastic container. This arrangement often causes anxiety since residents, who have previously relied on the staff to provide their medication at the correct time, must now depend on themselves. These concerns are echoed in the returns from the probe packs - in the postcards, for example, which persistently focus on issues of illness and pain (as in Figure 4) and in the photo taken of the food cabinet where a list is displayed of foods the resident needs to be wary of for medical reasons (Figure 5)
Figure 4: Postcard
Figure 5: Food I should try to avoid The probes also provide us with some notion of the mundane rhythms and coordination of everyday social life. The probes reveal what Zerubavel [16] calls the ‘temporal rhythms’ of social life; a notion that provides a way for us to think about person’s everyday activities - visiting people, going shopping, taking medication - repeating themselves over time as they get absorbed into and become the routine of everyday life in the domain. The notion helps us understand aspects of everyday life in these settings by highlighting its intrinsically temporal and cyclic nature. In the everyday life of the hostel residents, a number of rhythms can be readily perceived - visiting rounds, movement of residents into, around and out of the site at various times of day, medication delivery, resident and staff meetings, and so on. Such rhythms were not only important to the staff for coordinating their work but also for the residents, serving both a communicative and a therapeutic function. Knowing that events should happen in some sort of regular and predictable order, what people were doing, and where they were from was of value to both staff and residents. Amongst the elderly we have found that these rhythms are detected and played out in the visits to the Church and the visits of friends and relatives that are documented in the diaries (Figure 6). The rhythms of daily activity orient people to their present and future activities and the requirements of those activities. Such knowledge allows them to plan their activities accordingly. Current activities are crafted with an orientation towards expectations of future events - for example, knowing that a visit and talk, or a trip to the shops or the dentist etc will take place at a particular time.
Figure 6: Diary entry. What has emerged from our investigations of residential settings, even those as unconventional as community care settings, is that everyday life is made orderly by members through the accomplishment of routine activities that give reflexively rhythm to their lives. From our perspective design is concerned with interventions into these orderly, rhythmic settings to support the timeliness, reliability, dependability, safety or security of everyday activities. Explicitly orienting to and paying careful attention to the orderliness of everyday life in residential settings provides one way in which a philosophy of care may be integrated into the design of assistive technologies and ubiquitous computing more generally, in much the same way as other philosophies such as the scientific and the modern for example, have already been incorporated into design. ABIDING CONCERNS AND DESIGN
Although our research is at an early stage a number of early design prototypes for the hostel have already been developed, many of which focus on supporting various forms of awareness amidst the rhythms of everyday life and work. An overwhelming and understandable preoccupation with security highlighted the need for various forms of location awareness devices that would allow staff to monitor residents and increase the resident’s sense of safety and reduce their anxiety. However, any device needs to meet some rather strange dependability requirements dictated by the setting. In particular the
device should not have any significant commercial value or appear attractive enough to be worth stealing because of fears of encouraging the assaults the devices are intended to prevent. Any device needs to be highly dependable both in terms of location accuracy and the ability to communicate information in a timely manner, and to provide its user with simple but immediate feedback if there is any problem with obtaining a location fix and/or communicating the distress call. In order to encourage residents to feel safer while traveling between sites we are considering the potential for issuing personal panic alarms. When activated, such alarms would alert staff as to the identity and location of the person in distress. To respect residents’ rights to privacy, their location will not be tracked constantly, instead their location will only be communicated when the alarm is activated. In terms of location sensing, one approach that might be suitable would be to use a system such as E-OTD (Enhanced Observed Time Difference location technology). However, this solution is not currently viable because the modifications required to the base station infrastructure are not yet in place. The approach that we are currently considering is to deploy a device that incorporates a GPS (global positioning system) receiver and transmits the user’s current coordinates via a GSM (global services mobile) connection whenever the alarm button is pressed. Our original idea was to incorporate the device into a mobile phone - since most of the residents appear to own one. However, mobile phones are themselves valued and valuable devices (i.e., worth stealing and sellable) and one of the most significant benefits of the proposed panic alarm device is that it need not be incorporated into a mobile phone and consequently is less likely to be perceived as worth stealing. We have also identified a range of requirements regarding design of technologies to support medication [1, 11]. Residents primarily need a system that will reassure them that they are following the correct regimen, whilst leaving the task of managing their medication in their own hands. It is important that the system does not take over the task as many commercial products attempt to do by fully automating the dispensing of drugs at the correct time. The aim here is not to automate a task but to encourage selfreliance as a stage towards developing independent living skills. Our prototype consists of a simple box divided into compartments separating individual doses. This compact form-factor can be easily restocked and delivered to the resident’s accommodation. The box acts as a replaceable cartridge for a separate housing containing the medication management device.
Figure 8. Prototype medication manager. The transparent pill container sits on top of a layer containing a grid of coloured light emitting diodes. Each compartment has two lights to indicate which pills can be taken and which not. In this case red and green lights are used as it is a familiar color combination. If these colors pose a problem (e.g., with color blindness) they can be easily replaced. Once a pill is taken or has been missed the lights go out indicating that the compartment is no longer ‘live’, and should be ignored. This design provides residents with visual reminders of when to take medication and provides reassurance that the correct medication is being taken. Omitting the use of audio reminders or other more tangible reminders, forces the resident to actively check on the current state of the lights thereby reinforcing the routine.
Figure 9. The Medication Pack The information from the probes as well as the ongoing ethnographic work and subsequent ‘design workshops’ we have held with members, have suggested the utility of messaging systems and displays to assist in the coordination of everyday activities as well as for emergencies.1 At present staff activity is coordinated through the use of a diary, noticeboard, a telephone answering system, and an on-call pager system, but research revealed a number of instances when this proved less than satisfactory. Consequently we have embarked on developing an SMS public display system for hostel staff. 1
Design workshops with members enable us to engage in Cooperative Design and to incorporate user-based evaluation into the design process.
The system is designed to run a SMS message public display application, allowing users to send a text message to a public display, thereby allowing staff off-site to inform their colleagues of important information.
has been stolen to date and in another case the polaroid was used to take naked pictures primarily of bottoms, for example. Nonetheless, and as Gaver puts it, the probes have
The result of this work is a specialised miniature PC package, providing GSM connectivity and touch screen functionality. Although the device has yet to be deployed we anticipate further developments involving resident texting and the installation of devices into the residents room where it is anticipated they may well perform a similar communicative and coordinating function allowing the use of the system to display medication reminders, diary updates, rendezvous etc.
… provoked the groups to think about the roles they play and the pleasures they experience, hinting to them that our designs might suggest new roles and new experiences. In the end, the probes helped establish a conversation with the groups, one that has continued throughout the project. [9] For us, they have also provided us with a great deal of information and insight into members abiding practical concerns. Design is routinely confronted by messy indeterminate situations. Before designers can solve a design problem they need to understand something of the basics - such as what situation they are designing for, what solutions should do, and who should use them. The ‘turn to the social’ in system design proposed a new emphasis on the user, and a new kind of end-user especially, namely, a living, breathing person situated in real world settings along with others, rather than some abstract homunculi. While we have long been strong supporters and practitioners of ethnographic research into real world settings of use, confronting care environments has made us realise that a significant shift in our investigative techniques is required if we are to be able to consider how technology might usefully relate to unconventional settings and users. Ethnography, in short, requires the use of supplementary methods in such settings where direct observation may be intrusive and disruptive and is not at all easy to carry out.
Figure 10. The SMS Messager CONCLUSION
I can tell you something but you have to be careful what you make of it. [14] In moving towards what might be termed ‘appropriate design for design with care’ we are required to make a perceptual shift in order to determine the needs of potential users and to reflect these needs within the overall design. Thus, when considering design for care environments, traditional technological approaches need to be supplemented by detailed investigations into everyday life. Cultural Probes may prove to be a useful part of the researcher’s repertoire, particularly where information and insight into the unique needs of novel domains is at stake. While we believe that overall the probes have proved successful we also recognise the need to think carefully about claims and expectations for any method. So far, for example, it is undoubtedly the case that our respondents have enjoyed using and misusing the probes - one camera
Moving out of the workplace into a diverse range of settings in everyday life, design is confronted with new research challenges. The turn towards new methods and other disciplines such as art to inspire and inform design is a direct product of the changing technological landscape and priorities - from the workplace to the home from the desktop to ubiquitous computing and more radical technologies and adventurous visions of the future. But despite this imaginative view of future technologies, getting such dreams to work generally means they must, at some point, meet the real world and engage with the needs of new kinds of users if they are to be sufficiently grounded. Despite the attendant hype that invariably accompanies new revolutions in design, promising in this case to completely transforming home life in all its forms, successful forms of domestic interactive technologies rely on their ability to fit into and resonate with the orderly nature of the settings they are intended to inhabit; or as Sacks [15] put it, on the their ability to be “made at home”. Uncovering the orderly character of domestic life wherever it may occur, and the abiding concerns of members therein, is consequently essential to the design effort and it is in this light that we view Informational Probes as an investigative
tool complementing conventional ethnographic techniques, grounding the design of the future in the abiding concerns and constituent needs of users in the real world. ACKNOWLEDGMENTS
This work is funded by the UK Engineering and Physical Sciences Research Council, Equator (http://www.equator.ac.uk/) and Dependability (DIRC) Interdisciplinary Research Collaborations (http://www.dirc.org.uk/). REFERENCES
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