Wellbeing Design Research: Four Part Framework, starting with Inbodied5

how design for
wellbeing?
and why doing so
is
so important

pbodycology
presentation by: m.c. schraefel, u of southampton, UK, based on work by m.c. with
Natasa Millic-Frayling, Microsoft Research, Cambridge UK and Richard Gomer, USouthampton and stats magic and cogitation
with Matt Kay, UWashington

© m.c. schraefel, 2013
Friday, 29 November 13

@mcphoo

how design for
wellbeing?
and why doing so
is
so important

pbodycology
The focus of the work is to ﬁgure out in HCI what is the territory, what are the dimensions for understanding research/design
opportunities for HCI around wellbeing


@mcphoo

@mcphoo
pronounced “em cee fu”
m.c. schraefel

CONTEXT: Connect with me on twitter @mcphoo about this and related work

@mcphoo

@mcphoo
pronounced “em cee fu”
m.c. schraefel

Just to make translating these slides easier, you might want to think of the small font notes in this reddish colour as the
voice over of the talk that goes with these slides.


@mcphoo

Current work in HCI/Wellbeing: What is the territory?
How explore and chart the territory?
Building maps is iteractive - note how California has changed connexion to the USA over time? - the presented work is an
effort at being an early cartographer of wellbeing


@mcphoo

Reason for a map, model, theory
Consistent Language, Measures, awareness in principled
way of where we’ve been; where we may need to go

@mcphoo

starting assumptions:
what is wellbeing?
what is the problem around wellbeing?


@mcphoo

what is wellbeing?
Being Excellent in a body
where the Brain is part of the Body
the body is a complex system
we perform BETTER when optimizing
i n b o d i e d
how can interactive tech help us get to the SKILLS we need to UNDERSTAND what we need to
perform our best as PHYSICAL beings?


@mcphoo

challenge?


@mcphoo

value

as a sedentary culture we have progressively moved to privilege brain based activities.


@mcphoo

value

not

we have dichotomized the brain away from the body


@mcphoo

current position

our technology acts as if the body does not exist other than as a transport
mechanism for the brain from one seated position to another


@mcphoo

our technology is designed to support this framing of the brain so that engaging with the body can be de-emphasized against
brain engaged activities from work to entertainment


@mcphoo

brain based - that is sedentary, screen
oriented work, is growing

40% GDP - knowledge work - UK/US

@mcphoo

But the state of the body effects the
brain in critical ways


@mcphoo

Let’s consider just sugar,
sedentarism and screen
reading


@mcphoo

Type 3 diabetes - insulin resistance of the brain, aka:

Alzheimer’s Disease

de la Monte, 2012

sedentary = stupidity
Whitehall II
J.

increase in myopia
Leo/Young 2013


@mcphoo

Type 3 diabetes - insulin resistance of the brain, aka:

Alzheimer’s Disease

de la Monte, 2012

one example:
remember: this is your brain? this is your
brain on drugs?
comparable harm may be:
this is your brain
this is your brain on sugar
sugar is in just about every processed
food (food product in a box and with a
label is usually processed)
As such increasing evidence to suggest
we’re out of balance on sugar. new work
is showing how harmful this overload is
for the brain, too.


@mcphoo

Work by de le Monte where Rats with normal diets are placed in a water
maze and comparied with rats that have brains that have been treated to
reﬂect “insulin resistance” an effect that builds up from so much glucose
that it can no longer be managed properly.
This case is a great example of how interaction with food affects
cognition, and cognition we’ll see shortly in discussion of the Nun Study
correlates with effect of physical state of the brain, too. These are key
interactions for TUNING awareness/evaluation


@mcphoo

here’s a sequence with normal food / insulin response rat to ﬁnd the
target island in 5.2 secs in a standard rat water maze


@mcphoo

now here’s the rat with an insulin
resistant brain

the rat swims passed the island several times; it literally has to bump
into it to ﬁnd it.

“after a day they don’t remember their learning” de le Monte

@mcphoo

Goal of Wellbeing Design


@mcphoo

Put this

back in


@mcphoo

Role of computation/
automation in
this Wellbeing
challenge?
All computers can do is automate processes. So in wellbeing, we’re asking the question, what
processes can be automated?
Part of the work of HCI is to understand WHERE the opportunities may be before getting at
WHAT to do.
Most of us are very keen to get at WHAT can be done - the work here is to say ﬁrst we need to
understand better WHERE we might have an effect


@mcphoo

state of the current commercial art in what might be considered wellbeing
design: things that count.
anything we can automate by a sensor, from ﬁtbits, to wiﬁ scales, to calorie
loggers.

Things that can count Things
(or doing what’s easy
for computers
to do)


@mcphoo

make a bug a feature:
“self-monitoring of
behaviour change”
in the literature this is refered to as self-monitoring
around persuasion for behaviour change.
ok. that’s maybe ﬁne.
but (a) is self-monitoring all there is? is there more to the
territory than this?
(b) what is the scope of a ﬁtbit for instance? is there an
exit strategy?

What’s missing?
What is the territory?

@mcphoo

Where are these
on the map?

so what we’re looking for iw where do these technologies ﬁt into a
wellbeing map? what’s going on in other parts of the map?
what ARE the other parts of the map?
where do we begin?

WHEN are these
on the map?

what is the territory of wellbeing?
what is needed?


@mcphoo

Tools for Exploration to chart:
what is the wellbeing design space?
where are points for intervention?


@mcphoo

4 part model to begin to map the territory for design

@mcphoo

start with the body

Part 1: in-bodied-ness


@mcphoo

In HCI in particular, the BODY has been
introduced to consideration as “embodied”
see Dourish 99 Where the Action Is for an
example of this kind of framing.
Embodied assumes that there are persons
who interact in physical/social
environments. That’s super.
embodiment however treats the body itself
as a black box.
For wellbeing, we need to be able to lift the
lid of the black box to understand the
interactions of the complex system that is
the body if we are going to design to
support it.

Part 1: in-bodied-ness
distinct from embodied

makes sense right?


@mcphoo

But how are we going to understand the body? This slide shows reps of 8 of 11 systems of the body from the nervous
system to the digestive system to skin and bone etc. Few HCI designers today will delve into this level of detail. As per
einstein can we get to a place as simple as possible, but not simpler? what is sufﬁcient?

Part 1: in-bodiedness
One way to understand in-bodiedness: 11 systems
@mcphoo

I’m proposing “the inbodied5” that offers a functional model of the body: that reﬂects 5 key operations of the body that
are (1) strongly correlated to our mortality and (2) that we therefore already perform - most at least daily if not more
frequently - whether we want to or not. Consider, for instance, we will fall asleep at some point. If we undersleep, there are
known functional effects. eg, it becomes difﬁcult to lose weight; memory is affected and stress levels can increase. So
someone trying to lose weight, we can through this model not just look at food, but at sleep. Someone wanting to socialize
better - we can look at movement - more paths, strongly supported in research. (refs on request if not in chi14!)

the inbodied5
in-bodied wellbeing
move
eat
engage
sleep
cogitate
Each linked by long research to mortality

@mcphoo

This point bears repeating: while these ﬁve components are life critical, the goal is NOT to treat them in isolation (as do
current apps, either eating or moving or sleeping - even tools that support monitoring of each of these like jawbone’s UP do NOT show how these factors inter-relate).
A key approach for more holistic consideration, and i argue based on coaching, much more effective, is to treat the person
as an holistic being. Each of these attributes affects and is affected by the others. Complex systems. Paraphrasing einstein,
as simple as possible but not simpler. Eating alone, movement alone - too simple. we need the interaction.

the inbodied5
in-bodied wellbeing
move
eat
engage
sleep
cogitate

@mcphoo

Holt-Lunstad, J., Smith, T.B.,
and Layton, J.B. Social
relationships and mortality
risk: a meta-analytic review.
PLoS medicine 7, 7 (2010),
e1000316

in-bodied wellbeing
move
We need SKILLS to be able to perform well in social
eat
engagement with others IN THE REAL (not the digital) - we
are wired to deal with particular components of PHYSICAL
engage
(or embodied in this case) interaction
sleep
cogitate
WHile eat & move & to a lesser extent sleep are already
keen (isolated) focii of wellbeing apps, engage and cogitate
are less so - but they are it seems just as critical. See HoltLundstad’s meta-review of effects of relationships on
mortality. Strongly correlated.


@mcphoo

Holt-Lunstad, J., Smith, T.B.,
and Layton, J.B. Social
relationships and mortality
risk: a meta-analytic review.
PLoS medicine 7, 7 (2010),
e1000316 in-bodied wellbeing move
I
too
am
very
keen
to
examine
whether
such
digital

environments
offer
similar
benefits.

If
so,
there
is

great
poten>al
for
increasing
sociability
and

interven>ons.

If
not,
the
fact
that
it
is
so
prevalent

would
suggest
that
individuals
(and
society)
will
be
at

increased
risk.

eat
engage
sleep
cogitate

This quote is from my question to H-L as to whether her review showed benefits of digitally mediated social interaction. The
answer was no - the long studies wind up in 2002, predating face book. As she notes, it’s not clear that switching to digital for
social mediation translates to similar benefits. Ask someone if they’re more comfy online or off dealing with people. If the
preference is for online, it may be because we’re missing skills that are just as crucial there as knowing how to feed ourselves
effectively.


@mcphoo

Likewise the nun study shows that nuns who demonstrated in their writing high idea
density did not manifest symptoms of Alzheimer’s, though their brains looked like
they should have had AD. Hence, rich cognitive engagement creates neuro-physical
defenses/resources in the body.

in-bodied wellbeing
move
eat
engage
sleep
cogitate
Cognitive Engagement: Idea Density

@mcphoo

Much language of wellbeing is around “behaviour CHANGE” - change sounds so radical. If we are
focusing on functions we carry out everyday, why not think about TUNE’ing that practice rather
than “changing” it.
In my experience as a coach, helping someone work with what they’re already doing, tuning it,
making it more effective, has often been a far more effective path for evolving better, more effective
practices to optimise wellbeing.
How can our app designs help discover current practice and help tune that practice?

in-bodied wellbeing
move
eat
engage
sleep
cogitate
Tune rather than “change”

@mcphoo

part 2: descriptive decision: design ops

2nd part of design research model: what does engagement with a
tuning practice look like? We explored decision models to be able
to map points where support has an opportunity to act. The goal
being if we can understand specific points where intervention is
possible we can evaluate strategies/interactions at these points for
efficacy, vs at other points. We can also ask, critically, HOW do we
get into ANY of these points?

Opportunities for Intervention:
OFFLOAD
OUTSOURCE
DIY

a key concern here has been Natasa
Millic-Frayling’s insight that we Offload/
Outsource our requirements at these
points - whether it’s to offload meal
care to a restaurant or to a ready meal
for example; or movement to a trainer.
Can design interventions fit into these
offloading moments?


Values
Beliefs
Knowledge
Access
Support

rational decision theory
theory of planned action (self-efficacy)
affective modeling
evolutionary process
many many coaching sessions

@mcphoo

Example walk through of cylce:

“Wow, you’ve put on weight, eh?”

To see where opportunities for
intervention are, lets walk
through this wellbeing decision
process to assess a new or
tuning practice.
it starts with a trigger, like in this
case someone saying “you’ve put
on weight”
a doctor, a friend, a nasty
colleague may all be sources for
such a trigger. Here it was a
colleague


@mcphoo

Wow, you’ve put on weight

a. The next step is to assess if this assertion is true:
there is a measure of STATE (am i fat? - check put on
skinny jeans haven’t worn in 10 years). There is a
measure of process (how did i get here? - i haven’t
been very active, gone to the gym)

Wrong Measures?
b. But what if these are the wrong measures for best tuning?
It’s well established now that the best path to weight reduction
is food. As a colleague sums up the research “you can’t outrun
a donut”
How can design help connect with the RIGHT measure


@mcphoo

Wrong
Identiﬁcation?

The next step is to identify options again - what is informing the choice?
There is then cost/beneﬁt analysis:
what informs this selection? picking
something like the treadmill because
it’s at work may actually be less
appropriate than another practice
that may be more sustainable assuming it’s an effective thing to do
for a particular purpose


@mcphoo


@mcphoo

“i’m
broken”

Reassess

How many times is the practice repeated
before it is remeasured? what helps with
this part of the process?


@mcphoo

i’m doomed

Where reﬂection may lead to
wrong understanding, and thus
decisions that are inappropriate,
and reassessment that can lead
to faulty conclusions, then the
person can create new beliefs
about a practice that can lead to
suboptimal practices
Where can computational
processes intervene in this cycle?

“Exercise sucks...i quit”

@mcphoo

OFFLOADING
OUTSOURCING
DIY
beliefs values knowledge
Opportunities for new techno
new culture
how get to right sources


@mcphoo

OFFLOADING
OUTSOURCING
DIY
Opportunities for new techno
new culture
how get to right sources
We see these four key moments as points where we
tend to ofﬂoad our practices to another party or we
try to DIY something based on beliefs, like the last
example.
Ofﬂoading might be buying boxed meals at the store
rather than buying whole food and cooking it, or going
ot a restaurant.
Outsourcing might be trusting a trainer.
These are intervention opportunities


@mcphoo

In our surveys we saw that apps were not used for advice. And that
mainly only experts consulted other experts. Most used books or
friends as information sources for practice. How leverage these
paths for interaction intervention?

Decision Cycle: Action

drilling in: interviews
Not considered experts; like to “hack”
Scared of Experts: bad experiences; bad results
Expertise gained through reading; self-directed


@mcphoo

A current health app UI treats all food components equally. Is being low on fiber
really as critical for attention as being low on protein? (there are only two essential
nutrients: essential amino acids and essential fatty acids; there are no essential
starches(including fiber)/sugars) This lack of discrimination lead one participant to
focus on fiber to the detriment of protein.

how get to right measures?

who says these are
the right measures?

@mcphoo

Right OFFLOADING
Practice? OUTSOURCING
DIY
“no time”
EXAMPLE

What we have found is that
someone saying i have “no time”
for something like cooking usually
means
1) i haven’t really done it before
2) i also don’t know how or what
to do
3) i feel some shame and fear and
guilt about this because i think i
probably should
how can design catch and interact
with “no time” and create safe
interaction?


@mcphoo

Next part of our model is moving from evaluating a new or tuned practice to getting it to be
routine - we need to talk about what we mean by routine, practice and habit.

part 3: translation to routine practice (with a bit of habit)

@mcphoo

forget habits (well, good luck); think skills
create robust practices
Routine =
Reps =
Learning =
a Practice
how get reps
for skills?
habits are defined to include efficient repeatability that is cued by context, reflexively, unconsciously. What happens when
the context isn’t there? Like someone who can’t action their good eating habit from home when they’re on the road or
out for dinner. I’d suggest that instead of “habits” associated with “behaviour change” we challenge ourselves to design
for robust PRACTICES that are skills based and can survive context changes.
The example here is of Bear Grylis who’s famous for surviving any environment - he has some basic heuristics he
follows - find protein and water - and has skills that can be applied to a variety of environments. As Natasa asked this
summer, how do we create that kind of Bear Gryllis survivor for the grocery store or more challenging - a fresh
produce market? How do we create both the SKILLS and OPPORTUNITIES for REPS?


@mcphoo

forget habits (well, good luck); think skills
create robust practices
Routine =
Reps =
Learning =
a Practice
how get reps
for skills?
Here’s a potentially huge op for HCI wellbeing design: learning skills takes reps. If we only eat a few times a day, we only
get in a few reps, not hundreds in a day, less than two dozen in a week.
Computers are great at simulations.
Are there opportunities for wellbeing simulations to provide opportunities for skills development towards context
neutral practice?
Are these also complex skills: eg, learning to ask a server at a restaurant to prepare something off menu is both
knowledge that this is possible and an inbodied5 ENGAGEment skill. How support developing reps for both these
skills?


@mcphoo

Types of play
jokes
One way to encourage REPS in a safe way is
to look at PLAY.
Cunnane in Survival of the Fattest
stories
argues PLAY - not the fight or flight of
desperate food search - is where our tool
games
building happened - exploring options
happens in a safe place; not a life or death
tinkering
stress moment.
Stuart Brown in PLAY talks about various
...
types of play from games for friendly
challenge/competition, to jokes, stories and
tinkering among others.
Outdoor play with others in particular is
fabulous for engaging the body, developing a
demand for food, having to engage the brain
both to strategise and engage with others,
and providing a driver for recovery as well
as to blow off the fight or flight stress
hormones. Play is also where we can learn
and practice skills in an error free
environment.
How harness play for robust practice, er,
practice?


PLAY
Types of play
(flow)
@mcphoo

Types of play
jokes
stories
games
tinkering
...

PLAY
move
engage
cogitate

A very intriguing example of engagement with a practice, of translating it into something with
fun and creativity is the gamiﬁcation of a practice. Zombies, Run, uses the story of zombies
chasing players/runners: runners listen to the story as they run and they get updates on their
mileage and how far to a next target. They are running to DO something as opposed to run
itself. Narrative is a keen type of play, and being able to make a routine practice PLAY is a well
known great way to help develop skills.
How help make the social element of ZR more real than virtual??
(thanks to Elizabeth Churchill for pointing me to Zombies, Run...)

Zombies, Run!

@mcphoo

One’s own practice may also be game-ified in terms of competition.
the Strava app combined with a bike computer enables one to record, compare and share ride
information and it encourages one to see how they’re doing against others.
Of course one can compete against oneself: the computer is used for real time monitoring of
performance on multiple attributes from speed to heart rate to power during an activity as well as
for reflection. A fitbit on steroids

Translation to Routine
Technology enhances EXISTING practice
with adding Values:
- sharing//comparing/real time feedback


What’s not entirely clear is the degree to which one’s practice is “changed” by these tools rather
than, as we argue, TUNED by these tools. We did not get reports of *much* more cycling because
of the tools, but that the quality of the engagement already planned seemed to beneﬁt.Yes there
were reports of oh i have to work harder to catch my friend, but that again is quality within an
activity rather than MORE or CHANGE or NEW.

Translation to Routine
Increase inbodied5 Ratio,
higher traction.


move
engage
cogitate

What we also saw is that where technology was being used as part of a practice - like a fitbit - was
to mirror and validate existing practices. A participant who took a lot of stairs during the day was
delighted to see stair climbing reflected in the fitbit.
NOTE: It did not increase practice or change it; it validated an existing practice. Do mirrored
practices need reinforcement, thought?
Is mirroring a potential way to nudge an existing practice?
For a number of participants, the social connection that fitbit facilitated became almost more
important than the step monitoring.

Routine, Practice And Technology
Use of Technology
where part of (existing)
routine

mirroring || Validating
(but is it right?)

Design Caveat
We also see practices change: cycling now means cycling with the computer; running now means zombies run.
We may wish to consider if we want to deliberately design a revised practice rather than consider skills
building and an exit strategy for a monitoring device. It may be ﬁne to have running = running plus heart rate
montior - but what does that particular tech dependence mean? are we designing for that deliberately or
accidentily

interactive technology becomes “the practice”
or assists “a practice” to develop?
integration or exit strategy?

@mcphoo

Overview: forging
robust practice
Routine =
Reps
Learning a
Practice

The biggie takeaway about developing a
robust practice is that it takes reps, and
it’s very challenging for most of us to get
PRACTICE at our practice what is practice shopping? what is
practice cooking? or socializing? or
recovery/sleeping?
how can interactive tech help here?

Routine structure
for dynamic
skills

@mcphoo

technology produces culture
what culture are we creating?


@mcphoo

Another caveat: technology creates culture.
as we saw earlier we have reiﬁed a sedentary culture with all
sorts of systems to privilege seated, screen based interactions,
where the rest of the body is treated often with the equivalent of
a feed lot or factory farm life.
These (infra)structures are cultural.
1) we are potentially designing against the cultural grain - how do
we do that successfully?
2) should our design targets be higher up the chain towards
industry and govn’t interaction rather than individual?
new infrastructure design?

4th element of model: technology creates culture
technology of culture of wellbeing?

An example of change: processed foods were used as a way for women to get out of the kitchen (faster). Does the call to
whole food/home cooking away from processed food, for instance, for wellbeing, risk re-introducing gender roles/
limitations? How bring these factors into our design work consciously?

(Design) Tensions

Values
Beliefs
Knowledge
designing against cultural norms/beliefs

@mcphoo

culture =
communication of
values
eg
status (quo)
education
privilege (or not)
social engagement
rules


@mcphoo

Film Wall-e as embodiment of where the current practice of bodiless
screen-ness is going

By being aware that EACH OF OUR DESIGNS contributes to a reinforcement of or challenge to current culture, we may ask ourselves
more deliberately - what are the cultural assumptions at play in my
design? is this what i wish to reinforce?


@mcphoo

There are alternative cultures
Alternative values, beliefs and practices.

burn the chair

How does design help us get there?
What is appropriate individual focus?
What industrial, 3rd sec, govn’t?
@mcphoo

Reality Check
When i think about the folks
who currently lead ﬁelds of
interest, they embody the
inbodied5.

who are your research innovators/leaders?
their inbodied5?
@mcphoo

@begin2dig

Play
decisions vs routines
ofﬂoading
outsourcing
Access

This talk has been an effort at a sketch
of a model, a set of tools like the
inbodied5, decision cycle, reps for
robust practices, tuning rather than
change, and deliberate culture creation
as a means to begin to sketch a map
for more deliberate design
intervention

accelerating Experience

guidance
option discovery
accelerating REPS

Test/reassess

@mcphoo

move
eat
engage
sleep
cogitate
The hope is that in this talk we have
begun to have a better sense of the
scope of the domain where we might
intervene for design (get California
at least connected for the time being
to the USA)


@mcphoo

The model is multi-dimensional: a way to think about the inter-relations of the body as a complex system opening up
more design paths for TUNING (sleep affects body comp; movement affects cognition etc...); the descision cylce’s
outsourcing are targetted moments for intervention; developing REPS to build skills/practice and the act of designing
wellbeing as culture - that current cultural assumptions affect our designs: how become conscious of designing with or
against that grain

move
eat
engage
sleep
cogitate

values
knowledge
beliefs

Routine =
Reps =
Learning =
Practice

Technology /
Culture

4 part in-bodied well being model

@mcphoo

Keep in touch - let me know what you think
twitter @mcphoo
http://ecs.soton.ac.uk/~mc

Questions/Thoughts Welcome

values
knowledge
beliefs
move
eat
engage
sleep
cogitate

@mcphoo
Routine =
Reps =
Learning =
Practice

Technology /
Culture

4 part in-bodied well being model

@mcphoo

bonus slide:
why coffee w double cream
vs
pizza

if you do dairy...
whipping cream, unlike pizza (crust esp)
is all fat and protein - no carbs; mostly fat with healthy fat like CLA strongly associated with promoting fat loss.
Fat doesn’t disrupt RER - respiratory exertion rate - so doesn’t trigger (much of) an insulin response. That
means triggering the storage of glucose as it enters the blood stream.
Thus staying in more of a fat burning mode.
Double cream - being closer to a whole food as well - has higher satiety cues than processed foods.
Caffeine also has some interesting properties for mental acuity - if taken early enough in the day not to disrupt
sleep.
Some have also argued that starchy carbs tend to turn on the Grim Reaper genes rather than the Sweet
Sixteen (google it, eh?)
So, if i’m trying to maintain fat burning, and i haven’t just done some big exercise bout depleting glucose from
muscles, and if i’m extending an overnight fast to get a little more fating beneﬁt, this is a not bad way to go to
get to dinner time.


@mcphoo

Wellbeing Design Research: Four Part Framework, starting with Inbodied5

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