XXIV.5 September - October 2017
Page: 24
Digital Citation


m. schraefel

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The Abracadabra series invites us to share a "heartfelt wish" for the future of our discipline. My big wish for HCI/UX concerns our work in health and well-being. Globally, our current cultural norms are unhealthy. We know the stats: We are sendentary, underslept, and overfed on cheap calories of low nutritional value; we spend more time on screens than with each other. It's no wonder that work in health HCI has been growing so rapidly over the past decade. But what effect can we claim to have had? At what scale? What are our grand successes? What have we done to #MakeNormalBetter?

My overall aspiration for HCI is that we challenge ourselves to have an impact on health and well-being at scale—that we design work from the outset that clearly contributes to create a "better normal" of a more healthy and resilient, brilliant and joyful status quo. Putting positive health and well-being together, we need a new wellthy normal for all.

Toward this aspiration are three HCI inter-wishes:

  • To enlarge the space of health and well-being in HCI from an illness-prevention or disease-management focus to one that emphasizes performance, including physical, social, and cognitive performance
  • To expand HCI education to include how the body works on the inside, from physiology to kinesiology to neurology, and the many steps in between
  • To shift our gaze from the individual to include infrastructure.

Inter-wish 1: From prevention to performance. The focus on performance draws on lessons from sports science, where the body is a path to excellence, not an obstacle. HCI's current emphasis on health is largely centered around a prevention model. It's almost as if the body is framed as an annoyance: something that will make us sick, remove us from our lives. Prevention is a focus on delaying a negative outcome. Performance is almost the opposite: The body is the locus of attention in a positive way. One focuses on its development, from skills to strength, to enable one to excel. Sports and neurological sciences have also shown that a side effect of fitness is enhanced cognitive performance: The more fit we are, for more of our lives, not only are we more resilient, but we are also, effortlessly, as a side effect, more brilliant (see, e.g., neuroscientist John Ratey's research overview [1]).

A focus on performance also lets us focus on immediate values—and how much easier these are to support when we are wellthy. For a knowledge economy driven by innovation and creativity, there are two immediate payoffs of wellth. First, the more fit we are, the more effectively we can deal with stress. The less stressed we are, the easier it is to be creative in problem solving and innovation (a model of how that works is discussed in [2]). Second, by shifting from thinking about health practices as illness prevention alone to include a performance focus, we get illness prevention as a side effect of performance practice. We also have more immediate motivations for better physical practices: We may wish not to be ill in the future, but we may need to be less stressed and more creative today.

The more fit we are, the more effectively we can deal with stress.

Performance design example: Imagine designing tools to support walking meetings, not only because they reduce sedentarism (a far-off illness-prevention focus), but also because they help blow off stress and thus enhance insight (an immediate performance/values focus). In terms of HCI evaluation, we can leverage the far more immediate markers of reduced stress and enhanced creativity in our assessments of our interaction designs/systems.

Inter-wish 2: Inbodied interaction education. A focus on performance takes us to the second inter-wish: for HCI researchers interested in wellth to become better educated in "inbodied interaction" to support embodied interaction.

As a strength and conditioning coach and as a nutritionist, I have had the opportunity through a five-year fellowship to train and certify people as well as carry out research in sports performance, particularly around understanding and addressing chronic pain in the workplace (e.g., [3]). That research and training about how the body works internally has informed my view on the value of a performance perspective. It has also given me the eye-opening experience of how an awareness of our internal systems, from hormones to gut to nervous system—and all the other 11 systems in between—immediately influences our state of mind and ability to perform in a knowledge economy. If we want to design for health and well-being, from performance to prevention, we will be far more effective and efficient with a better understanding of what's going on under our hoods.

There are historical precedents in HCI to include formal inbodied education in design training. Our discipline's roots in ergonomics include training in biomechanics and physiology, along with psychology and design. In current HCI, it seems this focus has narrowed. Our HCI courses teach something about the limits of muscle-brain coordination measured by Fitts' Law, and we also learn about how the brain deals with visual information in order to create better interfaces and sensible information visualizations. All important.


With human factors and its focus on ergonomics, one might argue, it made sense to spend more time on biomechanics in order to design for physical comfort, from chairs to cockpits to operating rooms. With our growing focus in HCI on designing to support health, surely the same arguments apply: Basic knowledge of our inbodied interactions will help us design better, more effective tools. As a step toward this goal, I offered a three-hour course called Inbodied Interaction this year at CHI 2017 [4].

Performance design example: The World Health Organization says that sleep deprivation is a global epidemic. Lack of sleep leads to problems that include decreased cognitive performance, fat retention, and chronic stress. If we in HCI knew more about these aspects of how the body works, we would not design "smart" alarms to interrupt our sleep; we'd look at the more challenging problem of how HCI can help us design interactions to get the sleep we need.

Inter-wish 3: Impact at scale. While helping one person sleep better is fantastic, to make a difference in the wellth of the planet, we need to design for impact at scale. After all, even if we were to design the best mHealth app, we would not change the health of the world, much less of a single city or even a school. To have more impact, more of us need to think about infrastructure, policy, and commercial interests from the outset, and about what needs to change in any of these to change normal.

HCI has contributed to innovations that have the potential to change normal by aligning with a group's values. Participatory and experience-based design demonstrate how systems from workplaces [5] to neighborhoods [6] can support new practices. A takeaway here is that design for scale seems to be more effortlessly effective when it aligns with and deliberately foregrounds the values of a group. Technology for large-scale deployments also does not need to be complex. Work in India, for instance, shows that creative use of low-cost ubiquitous mobile phones to support interaction between health workers and their communities can make a lasting impact [7].

Performance design example: Designing at scale is a complex challenge involving policy, resources, and social norms, as well as shifting contexts. We may be disappointed that an intervention in a school doesn't have sustained effects at home, or that resources at work—like fresh vegetables in a cafeteria—are not readily available for homes in urban food deserts. A design opportunity is to consider not just the interventions themselves but also intervention linkages to help bridge contexts for sustainable, resilient practices. We are not alone; we can design components to work together.

back to top  Onward

HCI has already had a tremendous influence on shaping how we access and engage with technology in ways that have changed cultural norms. The goal of this piece is to help inspire us to see new ways to create wellth, to work at scale to #MakeNormalBetter, and to show that we can do this if we:

  • Widen our field of view to include performance as well as prevention
  • Develop inbodied interaction knowledge to inform our embodied interactions
  • Challenge ourselves to design for value at scale—to make real impact at scale a marker of our evaluation success.

Cutting through each of these stages, we need to align the values of the community we're engaging with the aspirations of the design—where those values are enhanced deliberately or as a side effect of the intervention. For instance, if a community values creativity and is chronically under-slept, how do we align a technology intervention to (a) aid getting more sleep and (b) assess this act against more creative outputs? Challenging, but doable—with some inbodied knowledge and design savviness.

Wellth creation and wellth support at scale is a multi-factor, complex challenge, but we can apply our collective disciplinary genius to help change the world for good. Together, let's #MakeNormalBetter.

back to top  Acknowledgments

Support for the work informing the above has come from the Royal Academy of Engineering Senior Research and Research Chair fellowship programs, with support from Microsoft Research. The work is currently supported by the U.K.'s Engineering and Physical Research Council's Get a Move On Health Network+ program.

back to top  References

1. Ratey, J.J. and Loehr, J.E. The positive impact of physical activity on cognition during adulthood: A review of underlying mechanisms, evidence and recommendations. Reviews in the Neurosciences 22, 2 (2011), 171–85.

2. schraefel, m.c. Mobile being: How inbodied and embodied practice may inform mobile cognition. MobileHCI`15: Adjunct Proceedings.

3. Jay, K., Brandt, M., Jakobsen, M.D., Sundstrup, E., Berthelsen, K.G., schraefel, m.c., Sjøgaard, G., and Andersen, L.L. Ten weeks of physical-cognitive-mindfulness training reduces fear-avoidance beliefs about work-related activity: Randomized controlled trial. Medicine (Baltimore) 95, 34 (Aug. 2016), e3945.

4. schraefel, m.c. Inbodied interaction: 3 things you need to know about how your body works to lead HCI innovation. Proc. of CHI EA `17, 1205–1208.

5. Korsgaard, H., Klokmose, C.N., and Bødker, S. Computational alternatives in participatory design: Putting the t back in socio-technical research. Proc of PDC `16.

6. Bird, J. and Rogers, Y. The pulse of tidy street: Measuring and publicly displaying domestic electricity consumption. In: Workshop on Energy Awareness and Conservation through Pervasive Applications, Pervasive 2010.

7. Ramachandran, D., Canny, J., Das, P.D., and Cutrell, E. Mobile-izing health workers in rural India. Proc. of CHI 2010, 1889–1998.

back to top  Author

m.c. schraefel is a professor of computer science and human performance at the University of Southampton, U.K., and a practicing certified strength and conditioning coach and nutritionist. [email protected],, Twitter: @mcphoo, Instagram: @m.c.phoo

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The Digital Library is published by the Association for Computing Machinery. Copyright © 2017 ACM, Inc.

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