Designing technologies for intimate care in women

PhD ThesisDesigning for intimate care remains an underexplored area of Human-Computer Interaction (HCI): while technologies for health and wellbeing might be plentiful, technologies for intimate care are limited. Intimate care is associated with personal hygiene, bodily functions and bodily products, and is a lifetime practice that requires well-defined interventions – by the self, or supported by others. With a move to experience, HCI has explored and responded to some of the concepts of intimate care in recent research, by addressing taboo and life disruptions. However, a wider understanding and conceptualization of intimate care work is missing from the broader HCI discourse on health and wellbeing, as well as a distinct framework for negotiating the design of technologies of intimate care. Addressing this space is noteworthy, within a field that designs technologies to support, enhance, and improve human life (Kannabiran et al. 2011). It is possible that this is related to uncertainty regarding the challenges that technology might bring to intimate interactions, particularly the challenges faced in practices that encompass bodywork and proximity to hidden parts of the body, and the impact of troublesome topics upon wellbeing education. The aim of this research is to enquire into the integration of digital technologies and intimate care towards the development of technologies for engagement with intimate care practices in women. I seek to investigate a methodological approach with a focus on the woman to understand the challenges of designing for and with intimate care; explore the qualities of such woman-centered approach in practice. In this thesis I present three case studies that incorporate empirical methods and new designs that I developed throughout this programme of research. These include 1) ethnographic observations of women’s health physiotherapy within a clinic to understand the components of intimate care within a professional setting; 2) a design toolkit that explores e-textiles for teaching female pelvic fitness, delivered through a series of workshops in which discussions that blended humour and laughter made it entertaining and less embarrassing to ask questions and to express curiosity about intimate bodies; 3) Labella, a probe/intimate wearable for self-learning about hidden parts of the female body and a technology which encompasses embodied interaction, that aims to contribute to breaking down the taboo of looking at oneself to help reduce the barrier of selfcare. Furthermore, Labella aims to support knowledge of the other, while exploring perceptions of esteem and reliance towards practices of care within the body. These three case studies begin to explore and offer insights on how designing for intimate care is entwined in woman-centered approaches to design. ! iv! This thesis contributes to interaction design research and outlines a framework for designing technologies for and with intimate care in women. The research highlights how intimate care pervades personal and professional settings, and its significance throughout the lifecourse. Specifically, I contribute to an underexplored area of HCI, women’s health (outside maternal health) by focusing on a woman-centered methodological approach. In doing this, I explore this approach in practice through challenging existing practices of care within women’s health and by offering novel design concepts and devices, in which I explore humour in design as a method to support learning of sensitive topics and as a tool to diminish the taboo nature of the interactions. Lastly, I propose woman-centered design as a novel form of inquiry in design practice research

Woman-Centered Design through Humanity, Activism, and Inclusion

Women account for over half of the global population, however, continue to be subject to systematic and systemic disadvantage, particularly in terms of access to health and education. At every intersection, where systemic inequality accounts for greater loss of life or limitations on full and healthy living, women are more greatly impacted by those inequalities. The design of technologies is no different, the very definition of technology is historically cast in terms of male activities, and advancements in the field are critical to improve women's quality of life. This article views HCI, a relatively new field, as well positioned to act critically in the ways that technology serve, refigure, and redefine women's bodies. Indeed, the female body remains a contested topic, a restriction to the development of women's health. On one hand, the field of women's health has attended to the medicalization of the body and therefore is to be understood through medical language and knowledge. On the other hand, the framing of issues associated with women's health and people's experiences of and within such system(s) remain problematic for many. This is visible today in, e.g., socio-cultural practices in disparate geographies or medical devices within a clinic or the home. Moreover, the biological body is part of a great unmentionable, i.e., the perils of essentialism. We contend that it is necessary, pragmatically and ethically, for HCI to turn its attention toward a woman-centered design approach. While previous research has argued for the dangers of gender-demarcated design work, we advance that designing for and with women should not be regarded as ghettoizing, but instead as critical to improving women's experiences in bodily transactions, choices, rights, and access to and in health and care. In this article, we consider how and why designing with and for woman matters. We use our design-led research as a way to speak to and illustrate alternatives to designing for and with women within HCI.QC 20200930</p

Crimson Wave: Shedding Light on Menstrual Health

300-level Award recipient for 2018. Project completed for course CS 320. Supporting faculty: Orit Shae

"It's come around way too quickly!" Can technology help parents provide support during menarche?

Menarche is an important milestone and time of transition, where children and adolescents need information and support. Parents provide significant support, but barriers such as parents’ own lack of confidence and information interfere. Existing technology for menstrual health is not always appropriate or accessible to younger adolescents and children. We ran two studies: Study1, an interview and design study explored how parents support children for menarche, their use of technology for this, and to understand the gaps. Study2 evaluated a design concept based on Study1, to gain further insights. Our findings show that menarche is an emotional time for parents and children; parents provide support and shared sensemaking but there is space for technology in providing scaffolding for parents to provide further support. However, there is a balance between sharing or support and privacy or control that needs to be negotiated between parents and children. We conclude with some reflections

Journal article: An exploratory view of female reproductive health issues: A case study in Norway

The purpose of this study is to look at the history and state of women’s health today through global literature review and in semi structured interviews in Norway. The main purpose of research is that as women in the online discussion are increasingly expressing unmet needs for their reproductive health issues, it is important to explore further. The impact of the common conditions were investigated, as many of these conditions have faced stigma and dismissal, yet greatly impact a woman's life. The study was based on literature review searched on EBSCO and google scholar. After the literature review was conducted semi structured in depth interviews were conducted in the larger cities of Norway. Specialists in Norway are well informed and aware of common reproductive issues, however their specialties vary. Reproductive health care in Norway ranks very well, however many women still face lengthy delays and struggle to be taken seriously. There is a lack of sufficient knowledge on many reproductive health issues within primary health care. Patients suffering vulvodynia have an especially poor offer in Norway. PMDD is one area were little research is conducted. There should be more focus on reproductive health issues in Norway to remove the stigma and acknowledge the pain many women suffer through, especially in primary health care services. There are currently few options to cure women’s health issues, but there are options to manage them. Because many reproductive health issues fall between many disciplines, there is a problem with taking ownership.O objetivo desta tese é examinar a história e o estado da saúde das mulheres por meio de uma revisão global da literatura seguida por entrevistas com especialistas na Noruega. Este estudo é devido ao aumento da participação feminina na discussão sobre necessidades não atendidas sobre problemas de saúde reprodutiva e tem como foco explorar o tema com mais detalhes.O impacto das condições mais comuns foi investigado, pois muitas dessas condições enfrentam constante estigma e abandono, apesar de terem grande impacto na vida das mulheres. O estudo foi baseado na revisão de literatura encontrada na EBSCO e Google Scholar, como estudo exploratório. Em seguida foram realizadas entrevistas semiestruturadas com médicos em grandes cidades da Noruega. Os especialistas na Noruega estão bem informados de problemas reprodutivos comuns, mas suas especialidades variam. Os cuidados de saúde reprodutiva na Noruega estão muito bem classificados, mas muitas mulheres ainda enfrentam atrasos prolongados e lutam para obter tratamento sério. Faltam conhecimentos sobre problemas de saúde reprodutiva na atenção primária à saúde. Pacientes que sofrem de vulvodinia têm oferta especialmente fraca na Noruega. PMS e PMDD também são áreas onde há menos estudos. É necessário haver mais foco nas questões de saúde reprodutiva na Noruega, principalmente nos serviços de atenção primária à saúde. Atualmente existem poucas opções para curar problemas de saúde das mulheres, porém existem opções para gerenciá-los. Como muitos problemas de saúde reprodutiva se enquadram dentro de várias disciplinas, há um problema de apropriação do tema por uma especialidade médica

bump2bump: Designing and Evaluating Technology to Promote Maternal Wellbeing in the Transition to Motherhood

The notion of wellbeing is synonymous with feeling competent, supported and satisfied with one’s life. Understanding how to sustain one’s own wellbeing is important at times of significant life change. The transition to motherhood is characterised by major emotional and physiological changes, which can impact on maternal subjective wellbeing and affect pregnancy outcomes. While Human Computer Interaction (HCI) has begun to address some of the challenges in the prevention and treatment of affective disorders in vulnerable perinatal groups, approaches that promote holistic maternal wellbeing in the low-risk majority have received less attention. This thesis draws on the multidisciplinary legacy of digital intervention development, utilising best practice from eHealth and HCI. Six studies using quantitative and qualitative methods were conducted. Study 1 was a systematic, interdisciplinary literature review, which proposed an integrated framework of factors involved in the successful development and evaluation of digital perinatal wellbeing resources. Study 2 used qualitative methods to explore the contextualised usage of digital resources by perinatal women. Studies 3, 4 and 5 involved the iterative development and formative evaluation of a prototype (bump2bump). Study 6 used mixed methods to explore the longitudinal, in-the-wild usage of bump2bump by a group of women as they became mothers. This thesis contributes to current discourse in HCI on how technology might be used positively and presents recommendations regarding the development and use of digital resources in first time pregnancy. Digital resources are increasingly relied upon when community services are lacking, and usage of such resources is particularly nuanced at the transition to motherhood. Design features that support users’ trust in content, facilitate face-to-face interaction with local similar others, and provide brief, practical information were found to be most important in meeting user needs. These findings can be used to inform the development and evaluation of digital perinatal wellbeing resources

Tensions and paradoxes in electronic patient record research: a systematic literature review using the meta-narrative method

Background: The extensive and rapidly expanding research literature on electronic patient records (EPRs) presents challenges to systematic reviewers. This literature is heterogeneous and at times conflicting, not least because it covers multiple research traditions with different underlying philosophical assumptions and methodological approaches. Aim: To map, interpret and critique the range of concepts, theories, methods and empirical findings on EPRs, with a particular emphasis on the implementation and use of EPR systems. Method: Using the meta-narrative method of systematic review, and applying search strategies that took us beyond the Medline-indexed literature, we identified over 500 full-text sources. We used ‘conflicting’ findings to address higher-order questions about how the EPR and its implementation were differently conceptualised and studied by different communities of researchers. Main findings: Our final synthesis included 24 previous systematic reviews and 94 additional primary studies, most of the latter from outside the biomedical literature. A number of tensions were evident, particularly in relation to: [1] the EPR (‘container’ or ‘itinerary’); [2] the EPR user (‘information-processer’ or ‘member of socio-technical network’); [3] organizational context (‘the setting within which the EPR is implemented’ or ‘the EPR-in-use’); [4] clinical work (‘decision-making’ or ‘situated practice’); [5] the process of change (‘the logic of determinism’ or ‘the logic of opposition’); [6] implementation success (‘objectively defined’ or ‘socially negotiated’); and [7] complexity and scale (‘the bigger the better’ or ‘small is beautiful’). Findings suggest that integration of EPRs will always require human work to re-contextualize knowledge for different uses; that whilst secondary work (audit, research, billing) may be made more efficient by the EPR, primary clinical work may be made less efficient; that paper, far from being technologically obsolete, currently offers greater ecological flexibility than most forms of electronic record; and that smaller systems may sometimes be more efficient and effective than larger ones. Conclusions: The tensions and paradoxes revealed in this study extend and challenge previous reviews and suggest that the evidence base for some EPR programs is more limited than is often assumed. We offer this paper as a preliminary contribution to a much-needed debate on this evidence and its implications, and suggest avenues for new research