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    Principles of mHealth Design I:

    What are we doing and who are we doing it for?

    David Gustafson, [email protected]

    Donna Spruijt-Metz, MFA [email protected]

    mailto:[email protected]:[email protected]:[email protected]:[email protected]
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    Outline

    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 yourcustomers, internal and external?

    How do you get into shoes of the customer todevelop systems that best fit the customer?

    How do you use the knowledge that you get fromall this?

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    How this session works

    Take 5

    Nuggetology

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    Scope

    Be creative, open-minded

    And PRECISE

    (With the option to build on.) Scope will depend on customers

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    Identifying the internal customer

    Whats an internal customer?If you are an engineer, the health scientist on your

    team might be an internal customer (i.e. your owncolleagues and staff)

    Your university, tenure committee, department chair,or higher-ups in your business might be your internalcustomers.

    Your funders might, in some sense, be internalcustomers

    Internal customers might have differentexpectations, needs, desires, timelines andendpoints in mind

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    Conflicts between Customers

    Is it the most

    up-to-date

    technology?

    !t

    Has the

    accelerometer in

    that cell phone been

    validated?

    Proof of concepDone!

    Promotion =1st AUTHORSHIP

    IN JAMA

    But I need to be

    able to take this

    out into the

    field and use it

    with REAL

    PEOPLE!!!

    OMG(oodness)!!

    TRANSDISCIPLINARY

    MOBILE HEALTH

    SYSTEMS DYNAMIC

    RESEARCH WOW!!

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    Identifying the external customer

    Lets say we are developing a second skin ofsome type for obesity interventions in urban

    inner city Los Angeles youth.

    Who is the customer?

    Beyond developmental stage (impacts: Cognitivefunction and emotional control, thus learning

    styles, acceptability of various functions) Beyond ethnicity (impacts: Approach, acceptable

    diet and activity recommendations, language)

    Beyond SES (impacts: Everything)

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    Identifying the whole customer

    EVERYTHING IS A SYSTEM eliminates a lot of discussion (arguments?) about what is

    or is not a system.

    EVERY SYSTEM IS PART OF LARGER SYSTEMS opens creative solution space by seeking solutions to

    achieve bigger ends

    EVERY SYSTEM IS MADE UP OF SMALLER SYSTEMS provides a way of considering all aspects of reality

    EVERY SYSTEM EXISTS IN PARALLEL WITH OTHERSYSTEMS

    is a reminder that independence of systems is an illusion

    Dr. Gerry Nadler

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    Dan Stokols Early Vision of Socio-

    ecological Systems

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    Patrick, Intille & Zabinski

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    Second Skin in a System

    The case of KNOWME

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    Your case study

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    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, whats the hook (points of engagement)

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    Your case study

    Surprises about your customers that impactdelivery, messaging, technology, displays, data

    representation.

    (what kids will wear, what they want to hear)eMOTE

    (Enhanced Minority health Outcomes Through Entertainment)

    H d i h f h

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    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

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    CBPR 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 iterativeprocesses

    Disseminates findings and knowledge gained to allpartners and all partners will be involved in thedissemination process

    Involves a long-term process and commitment

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    Which Groups Come to the Table?

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    Which Issues Get to the Table?

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    Birds-eye view of CBPR

    Select the community unit of identity

    Select your initial partners individuals, representatives oforganizations or both

    True dialogue with partners (and others that should be at thetable) before the proposal is written and throughout theprocess

    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

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    From Systems Science:

    Group Model Building

    A form of group decision support, involving agroup of stakeholders with a complex problem

    Group facilitation

    Model building and refinement in publicSimulation of scenarios and options

    Extensive facilitated discussion and analysis

    Facilitated policy design and decisions

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    Nuts and Bolts

    Management team (10-20) with aModeling/Facilitation team (2-4)

    Four full days over 3-to-4 months

    Extensive between meeting work

    Rapid prototyping of model with finishedsimulation product

    Facilitation of implementation plans

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    Group Model Building (GMB)

    Group model building is a process in which team members exchangetheir 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 toinvolve 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

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    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

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    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 24

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    Example from a causal mapping

    exercise focusing neighborhood safety

    Sports teams

    using park

    Playing soccer

    Kick ball

    teamGetting sports

    teams together

    Gangs

    using park

    -

    -

    Policesearches

    Finding dope

    Cancelling

    program

    Connecting to parks

    outside community

    Condition of parks

    Rusting chains-

    City maintaining

    parks

    +

    Educational

    systemHigh dropout

    rate

    -

    Educational

    background

    Meaningful

    employment

    Time on hands,

    nothing to do

    -

    +-

    JobsMaintain home

    +

    Streetcleaning

    Crime

    Police not

    responding+

    Policeman on

    foot patrol

    -

    Kids not havingfathers in home

    +

    Gangs

    Parents can't

    control kids

    Not disciplining

    kids

    +

    +

    Community

    acitivties

    Police+

    +

    +

    Neighborhood

    pride

    Neighborhood

    schools +

    Churches comingtogether

    +

    Vacant houses

    and buildings

    +

    Getting loans to

    improve homes

    Condition of

    buildings

    Tearing down

    houses

    -

    + +

    +

    How do you get into shoes of the

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    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

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    Focus Groups: The Basics..

    Facilitated (trained moderator) Group Discussion 8 to 12 homogenous members, who dont know each

    other

    Audience segmented by level ofuse/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

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    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 participants level of change

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    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

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    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

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    How do you use the knowledge that

    you get from all this?

    This may seem obvious. But it isnt

    How will you analyze the data?

    Lay out software, mixed models, impact of one setof 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

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    Incorporating Findings

    Case study from the simple to the sublime

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    And now for something completely

    different!

    Dave Gustafson!