The document discusses person-centred design of technologies to support older and disabled individuals. It notes the aging population and increasing disabilities create a need to enable independence through assistive technologies. However, current technologies often make assumptions that exclude non-standard users. The document advocates for a person-centred design approach embodied in tools like MDDS and DTA to assess individuals' needs and ensure technologies enable rather than contain people. Appropriately designed assistive technologies incorporating personalization could support health and independence if focused on the whole person.

1. Guy Dewsbury PhD
www.gdewsbury.com
BCS Health Scotland, Edinburgh University
26th May 2014

2. www.gdewbury.com:
Enabling independence for older and disabled people through person-centred design technologies
Themes

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Enabling independence for older and disabled people through person-centred design technologies
HealthandTechnology:TheRationale
•Ageing Population
•Increasing disabilities
•Living longer
•Greater recognition of illnesses
• Limited economic
resources
• How can an increasingly
older/disabled
population be
supported?

4. www.gdewbury.com:
Enabling independence for older and disabled people through person-centred design technologies
TheUKGovtresponse...
Introducing assistive
technology in the form of telecare
and telehealth.
Technologies that can
enable people to maintain and
support their health.
Technologies that support
people in their own home
environment.

5. www.gdewbury.com:
Enabling independence for older and disabled people through person-centred design technologies
HealthandTechnology:theIntersection
Maintaining health in the
general population should increase
the ‘older well’.
This is supported by
 Health promotion
 Nudging health technologies
(e.g. apps)
 Social media
 Greater access to
preventative care (e.g.
screening)

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Enabling independence for older and disabled people through person-centred design technologies
HealthandTechnology:the
Interconnection
An implicit assumption is that
the population will embrace these new
technologies and become fitter.
Technologies such as the
“fitbit” are designed to support getting
fit and take exercise
“The Fitbit family motivates you to stay
active, live better, and reach your
goals...We'll help you achieve what you
set out to do, by sharing a full picture of
your progress over time.” (fitbit.com)
Also see http://www.quanttus.com/ The Fitbit Flex mobile tracker

7. www.gdewbury.com:
Enabling independence for older and disabled people through person-centred design technologies
SupportingPersonalisation
The idea of personalisation
is central to the UK Govt’s response
to the ageing society.
People should have control
over their own health (Maintenance
and Choice).
Technologies have been
developed to support health
promotion... For the able fit.

8. www.gdewbury.com:
Enabling independence for older and disabled people through person-centred design technologies
PersonalisedHealth
YOUR health is ...Your
responsibility.
YOUR illness is...Your
responsibility.
YOUR health condition
is...Your responsibility.
It isYOUR responsibility
to obtain/purchase what ever
technology would be beneficial
to maintainingYOUR health and
YOUR responsibility to source
and determine the best solution
forYou.

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Enabling independence for older and disabled people through person-centred design technologies
HealthatHome
Telecare and telehealth
enable a person to manage their
health remotely from their home.
Telecare alerts others when
something happens.
Telehealth alerts health
professionals and the person when
their health condition changes.
These technologies
promote independence and enable
people to remain in their own home.
Telehealth allows for
remote health management.

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Enabling independence for older and disabled people through person-centred design technologies
HealthatHome
The rise of the virtual nurse
and virtual ward are implicit in the
increase use of these technologies’.
Currently their are few
regulated criteria for the use or
uptake of these technologies.
This means anyone can
purchase them...

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Enabling independence for older and disabled people through person-centred design technologies
HealthatHome
In previous research (e.g.
Sommerville I & Dewsbury G (2007)
‘Dependable Domestic Systems Design: A
Socio-Technical Approach’. Interacting with
Computers. 19 (4): 438-456) many of the
issues with using technology to
support older people at risk were
outlined which included the poor
design of technology in homes
specifically designed to support
older or disabled people in the
community.

12. www.gdewbury.com:
Enabling independence for older and disabled people through person-centred design technologies
HealthatHome
Technologies to support
health tend to ignore the non-standard
user.
They rely on assumptions such as:
1. The person having access to
a computer;
2. The person being able to
open and modify text;
3. The person having access to
a range of movements;
4. The person being sighted
and have full hearing.
Take one example: the pendant alert
call button in telecare assumes the
person can press at a certain pressure.

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Enabling independence for older and disabled people through person-centred design technologies
HealthatHome
Three more assumptions:
Telehealth monitors assume
the person speaks, writes and reads a
language (usually English).
They also assume the person
will read the instructions, understand
and act on them... using the device as
intended.
They also assume the person
knows how to correctly attach medical
devices and to accurately take a
reading for upload to the remote
computers.
(see outputs from the ATHENE
project www.atheneproject.org)

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Enabling independence for older and disabled people through person-centred design technologies
HealthatHome
Just as the Fitbit assumes a
certain level of ability to move, so do
many current technologies used in
health and social care.
Smart homes, smart
devices, smart technology, pervasive
systems, ubiquitous systems,
ambient systems are often
developed without the person who
will use it in mind.

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Enabling independence for older and disabled people through person-centred design technologies
Enablementandcontainment
In 2008 I proposed the
enablement/containment model in
which I suggested that technology
should enable a person and not
contain them or their
actions/activities.
It is important to consider how the
technology will affect the person
and the levels of enablement vs.
containment in any system.
e.g. the door/wandering sensor

16. www.gdewbury.com:
Enabling independence for older and disabled people through person-centred design technologies
Person-CentredDesign
Person - Centred Design
(PCD) is a method I developed to
enable the appropriate design of
systems for older and disabled people.
PCD embodies and
incorporates the person throughout
the design process.
What it tries to avoid is over
simplification of data and responses.
PCD deals with ‘People’,
NOT ‘Humans’, ‘Patients’,
‘Conditions’ or ‘Users’.
People have emotions and
do not think in linear lines.

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Enabling independence for older and disabled people through person-centred design technologies
Person-CentredDesign
People are diverse and
every person has different needs.
People are not things or
medical conditions.
Take two people with
dementia, they might share the
same medical condition but their
lived experience of the condition is
different and their needs are
different.
This difference in ‘need’ is
captured in DTA and MDDS.

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Enabling independence for older and disabled people through person-centred design technologies
Person-CentredDesign
When we design
technology systems for people we
design for the whole of them,
including their activity patterns, and
the technology should fit into their
lives not them fit to the technology.
This means we have to take
into account the variety of
stakeholders (such as friends, family,
relatives, support groups, hobbies
etc) into the design.
Similarly, we should take
their activities and levels of isolation
into account.

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Enabling independence for older and disabled people through person-centred design technologies
Person-CentredDesign
Most importantly although
we can develop a generic design, we
have a design that is fluid enough to
incorporate the needs and wishes of
people and their future needs and
wishes.
Through a clear
understanding of a person’s needs
and their stakeholder needs’ any
design should have better stick-
value, and be less likely to be
rejected.
Most importantly it is
something that will be used.

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Enabling independence for older and disabled people through person-centred design technologies
PCDandAssessment
As a result I co-developed:
MDDS:The Method for Dependable
Domestic Systems
and
DTA:The DependabilityTelecare
Assessment tool.
Both were developed as a
result of ethnography, using cultural
probes with older and disabled people.
MDDS was developed at Lancaster
University as part of my PhD and DTA
was developed and piloted whilst I was
working at a large London Borough.

21. www.gdewbury.com:
Enabling independence for older and disabled people through person-centred design technologies
MDDS
The Method for the
Dependable Domestic Systems
(MDDS) provides a method for
analysing assistive technologies and
determining if they are suitable for a
person.
MDDS also includes a large
booklet of key questions for each
section and subsection.

22. www.gdewbury.com:
Enabling independence for older and disabled people through person-centred design technologies
DTA
The Dependability Telecare
Assessment tool (DTA) was developed
after MDDS specifically to meet the
need for a usable, robust assessment
tool for telecare, as at the time there
was none.
DTA is focused on the person,
and their ability to live independently.
It is based on three principles:
1. Technology should enable not
contain a person.
2. Technology might not be the
answer for everyone.
3. Not everyone requires or is best
served by a technological response.

23. www.gdewbury.com:
Enabling independence for older and disabled people through person-centred design technologies
DTA
DTA is a qualitative
framework that provides prompts
for assessors to consider the
person’s relative limitations and how
these impact on their quality of life.
DTA is built around
dependability factors which
highlight the core issues in any
system.
Armed with this type of
information it provides a
dependability pathway to the key
elements of the possible technology
required... or not.
Person
Environment
TelecareNeeds

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Enabling independence for older and disabled people through person-centred design technologies
TechnologicalResponsestoHealth
Although technology is
possibly the best response to the
health crisis, poorly designed
technology will only exacerbate
conditions and have the potential to
prove lethal, if not used
appropriately.
Technologies designed for
people must reflect the divergence of
the individuals who will use them.
Standardisation is
constructive providing there is also
customisation and personalisation
possible.

25. www.gdewbury.com:
Enabling independence for older and disabled people through person-centred design technologies
FutureTrendsandPossibilities
The future is now, as
technology develops so fast.
We see apps appear that
encourage healthy lifestyles but rely
on able bodied people to use them.
We have fitness devices
that rely on a number of
presuppositions in their use.
We have robots entering
hospitals and homes but they are
designed by the able bodied.
We have a world that omits
people who are not standard.

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Enabling independence for older and disabled people through person-centred design technologies
TheFutureof TechnologyandHealth
Without a person-centred
design framework in assessment,
there is a likelihood of over spending
on redundant and inappropriate
technologies.
Technology is not a panacea
and some people will reject it and
require other forms of response.
As we technologise health
and social care it is important to
never lose sight of the person who is
to use the technology in their daily
routine.

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Enabling independence for older and disabled people through person-centred design technologies
Conclusions
Appropriate technologies
should be a part of a person’s life
and complement their lifestyle
rather than be an appendage.
Telecare and telehealth
technologies that support people
should be person-centred and
responsive to the changes in people
as their abilities change.
Let’s not assume that
because technology exists it is
always the best response to a
situation.

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Enabling independence for older and disabled people through person-centred design technologies
ReferencesAndcredits
All images courtesy of Google Image
Search,Tynetec and gdewsbury
Suggested references
Wherton, J, Sugarhood, P, Procter, R,
Rouncefield, M, Dewsbury, G, Hinder, S,
Greenhalgh, T, (2012) Designing assisted living
technologies 'in the wild': preliminary
experiences with cultural probe methodology,
Journal BMC Medical Research
Methodology, 12(1), pp 1-13.
http://dx.doi.org/10.1186/1471-2288-12-188.
Dewsbury G (2012) Telehealth: the hospital in
your home, British Journal of Healthcare
Assistants, 6(7): pp338 – 340.
Dewsbury G and Linskell J (2011) Smart
HomeTechnology for Safety and
Functional Independence: The UK
Experience, NeuroRehabilitation
Journal, 28 (3): pp249-260, DOI
10.3233/NRE-2011-0653.
Dewsbury, G., & Ballard, D. (2013).
Telecare: a reactive service to enhance
patient care. British Journal of Nursing,
22(7) pp 364.
Dewsbury G and Ballard D. (2013) The
ethical Issues ofTelecare: a help or a
hindrance? Nursing and Residential
Care, 15(7) pp490-493.

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Enabling independence for older and disabled people through person-centred design technologies
Any Questions?
Thank you
for listening
Contact Guy
guy.dewsbury@gmail.com
Or go to:
www.gdewsbury.com
And see:
thetelecareblog.blogspot.com
@dewsbury