Side effects of technology

“If technology is a drug – and it does feel like a drug – then what, precisely, are the side-effects?”Charlie Brooker

Black Mirror is a TV drama about technology and its effects on people. I’ve discovered it only recently (thank you for recommending it, Marta!) and it’s hands down the best thing I’ve seen in a long while. It is a short series: at the moment only two 3-episode seasons have been released.

Episodes are individual stories. They are not linked by characters or the setting; they aren’t even linked by time or a location: some of these stories could happen now, some of them in the near future. The thing that connects them is everyday technology. Technology that always works the way it is supposed to work. It never breaks. And yet things go wrong anyway. Why? Because people.

And this is the reason why HCI researchers, UX designers and others who design technologies should watch this series. We all know that technology does not exist in a vacuum. Technology is nothing without users who give it meaning, adapt it, reinterpret it, or simply use it. Black Mirror shows how technology can become an integral part of life, how it can change people’s lives… Or rather, how people can change their own and others’ lives when technology is available and makes that change possible.

The series covers several topics: from social media to smart contact lenses and futuristic reality shows. Every episode has a main piece of technology on which it focuses (which characters simply use), but there is also technology in the background, seamlessly integrated into everyday world: super-slim mobile phones, gestures for controlling an email client or a curved drawing board. These extra technologies don’t play any important role in the plot, they are just everyday objects – like remote controls or kettles or laptops. People just use them. But at the same time these objects suggest how things might look like in the future. How they will almost definitely look like.

But the most important thing are people who interact with each other, who have feelings and who are driven by emotions. These emotions, when combined with technology, are the reason why every single episode is unsettling, disturbing, sometimes even creepy. People are people and technology helps them to be even more human. And after a while you find yourself wondering if this is a good thing.

In case you haven’t guessed that yet, I highly recommend Black Mirror. Stories are good and engaging, technology either already exists or is feasible, characters are believable and, to makes things even more exciting, they are from diverse backgrounds. Black Mirror is available on 4oD, so you have no excuse for not watching it.

~falka, 2014-06-09 21:17

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Technology and medication-taking habits

Sooner or later we all end up taking medications. And we forget them. No matter how motivated or how scared of the consequences we are, forgetting is incredibly easy: the reminder doesn’t go off or we don’t have the pills when it does, we’re travelling, we’re busy, distracted, stressed… and BOOM, we missed the pill, forgot about the tablet, misplaced the inhaler.

Even though we all forget, interventions aimed at supporting patients’ memory tend to focus on chronic, life-threatening, life-changing conditions (e.g. AIDS/HIV, diabetes, cancer, hypertension) and the elderly. But young people and those on preventative treatments (such as oral contraception) forget too, even when there’s only one daily pill they have to remember. And for them remembering is often more difficult, because they don’t have symptoms, don’t have to change their whole life, and they don’t self-identify with the illness (because there’s no illness!).

Remembering medications

People tend to take their medications at the same time and in the same place every day, and if they do it for longer periods, they finally form a habit. Habits develop as we repeat actions in a stable context: the brain creates associations between the act of taking medications and the environment, present objects, preceding actions, next steps in the sequence, internal states, etc. Soon enough medication-taking turns into a habit and becomes a part of a routine, which starts to guide the behaviour.

I conducted two studies that explored how people remember medications and looked at two contrasting “user” groups: women who take oral contraception (long, one pill only) and parents who have to remember their children’s antibiotics (short, strict, multiple doses per day). Among other things, I asked people how they remembered their medications and charts below summarise their responses (it was a multiple answers question; click the chart to enlarge it).

Click to enlarge

Both groups reported that daily routines were important in supporting their memory, although their role was different. For women taking oral contraception, the Pill would become a part of a routine or a routine task in itself, while parents relied on other existing routine events (getting back home, preparing meals, bedtime, etc.) as triggers. Detailed analysis of the data showed that survey respondents who reported relying on routines forgot less often than those who didn’t. The difference was statistically significant (yay!), which means that routines can’t be ignored.

What about technology?

Medication-taking is a prospective memory task, which means it is something we have to remember to do in the future. There are two types of prospective memory tasks: time-based tasks and event-based tasks. Time-based tasks are tasks that take place at a specific time or once a certain time elapses, e.g. taking medications at 9am or taking antibiotics every 8 hours. Event-based tasks are tasks that need to be completed once a certain event occurs, e.g. taking medications with your morning tea or right after waking up. Because of the connection with an existing event, event-based tasks are easier to remember: there are more contextual cues and the routine guides the behaviour. Unfortunately, most technologies ignore that and focus on giving people a reminder. They turn a habitual task into a time-based task, which is harder to remember.

If you look at the charts above, you can see that not many research participants reported using reminders, and I am not surprised. I conducted a review of functionality offered by 229 smartphone reminder apps (106 Android and 123 iPhone apps) and the results are summarised in the chart below (click on the chart for a bigger version). Full results of that study are described in detail in my paper [pdf] and in here I wanted to point out two main problems: 1. these apps focus on reminders and time-based tasks, and ignore the fact that taking medications is a routine task; and 2. their reminders aren’t even that good – most of them don’t even have a snooze option!

Click to enlarge

Making reminder apps better

So how can we improve reminder apps? For starters, we should make sure they support daily routines. We should also listen to Maria Wolters and reduce the presence of technology.

Imagine a reminder app that suggests routine events that usually occur around the time you want to take your medications, e.g. if you want to take your pill around 8am, the app can suggest taking it after shower, after morning coffee or with breakfast. Imagine also that it doesn’t give you reminders – instead it gives you tips how to remember by yourself and a few hours later asks you if you did it. It doesn’t really remind you – it helps you create your own medication-taking habit that fits into your personal daily routine. The best part? It’s totally feasible. Smartphone apps can do it. And I’m working on such an app at the moment.

Technology is becoming ubiquitous, but maybe we don’t always need it. Maybe there shouldn’t be “an app for that”. And if there is, maybe it should just do its job, help people help themselves and then disappear, instead of teaching them that they can’t live without it.

Further reading

Stawarz, K., Cox, A. L., Blandford, A. (2014). Don’t Forget Your Pill! Designing Effective Medication Reminder Apps That Support Users’ Daily Routines. CHI’2014. [url] [pdf]

Stawarz, K., Cox, A. L., Blandford, A. (2014). Personalized routine support for tackling medication non-adherence. Personalizing Behavior Change Technologies CHI 2014 Workshop. [pdf]

Stawarz, K., Cox, A. L. (2013). How technology supporting daily habits could help women remember oral contraception. Habits in HCI Workshop, British HCI Conference. [pdf]

Maria Wolters (2014). The Minimally Effective Dose of Reminder Technology. CHI’2014 – alt.chi [url]

~falka, 2014-05-07 13:47

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