mHealth for Maternal Mental Health: Everyday Wisdom in Ethical Design

Marguerite Barry
Marguerite Barry
Kevin Doherty
Kevin Doherty

CHI, pp. 2708-2756, 2017.

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Ecological Momentary Assessmentmhealth technologyphronesisdesign processBipolar disorderMore(13+)
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We have introduced an approach to applying phronesis in mobile health technologies for a more informed design process based on everyday wisdom

Abstract:

Health and wellbeing applications increasingly raise ethical issues for design. User-centred and participatory design approaches, while grounded in everyday wisdom, cannot be expected to address ethical reflection consistently, as multiple value systems come into play. We explore the potential of phronesis, a concept from Aristotelian vir...More

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Introduction
  • Mental health is a primary determinant of wellbeing and a major concern for society [83].
  • HCI research has recently started to focus on how technology can support psychological wellbeing [e.g. 1, 21, 78].
  • Some apps focus on physical and mental health during particular life events such as bereavement (Grief: Support for Young People), illness (CaringBridge) or pregnancy (Baby Bump, Mind The Bump).
  • Others focus on women’s health in particular, for example menstruation tracking apps (e.g. Clue), which offer a combination of mood and symptom tracking, analysis and feedback for monitoring both physical and psychological aspects of the monthly cycle
Highlights
  • Mental health is a primary determinant of wellbeing and a major concern for society [83]
  • User-centred design sessions are important in a mental health context, given the sensitive nature of these applications and studies recommend designers collaborate with mental health professionals as well as clients early in the design process for mobile health apps [22], with a particular focus on how to encourage and maintain engagement [21]
  • A point made repeatedly throughout the design sessions was how mental health struggles are still highly stigmatized in the general community, but even more so among pregnant women, who have real fears that admitting to experiencing psychological difficulties might result in their child being taken from them
  • We have introduced an approach to applying phronesis in mobile health technologies for a more informed design process based on everyday wisdom
  • The elements of applied phronesis that we describe are: 1
  • Our analysis shows that involving a large number of midwives as well as clinical researchers and medical practitioners produces value ‘conversations’ that result in changes to the ‘voice’ and tone of the app design
Methods
  • Design challenges for mHealth

    User studies and participatory design sessions are well established in HCI and digital media design, in order to identify and cater for user needs [61].
  • It must be emphasized that the participating midwives themselves represented a variety of ethnic groups, including those under discussion, and so their comments could be seen to reflect both professional and personal community knowledge
  • This illustrates the value of eliciting feedback from those operating closely with a target community who can identify assumptions and vulnerabilities in design where access to peer users is not possible.
  • They noted that an app could provide crucial access to younger women whose smartphones are an essential communication tool and to the many for whom admitting struggles with emotional wellbeing is still taboo
Results
  • Perinatal depression (PND) is one of the most common psychiatric disorders during pregnancy, affecting up to 15% of women during pregnancy or within one year of giving birth [8, 85].
Conclusion
  • The design sessions reveal insights into how an app could address the psychological wellbeing of people whose needs are frequently not met in traditional healthcare paths
  • It shows how even the most well informed designs following user-centred and/or participatory processes may not sufficiently uncover unconscious assumptions and may miss some ethical design considerations.
  • The Wider NetWe have introduced an approach to applying phronesis in mHealth technologies for a more informed design process based on everyday wisdom
  • This is not a new technique for designers, but offers a perspective on how to shape ethical reflection in design.
  • The authors' analysis shows that involving a large number of midwives as well as clinical researchers and medical practitioners produces value ‘conversations’ that result in changes to the ‘voice’ and tone of the app design
Summary
  • Introduction:

    Mental health is a primary determinant of wellbeing and a major concern for society [83].
  • HCI research has recently started to focus on how technology can support psychological wellbeing [e.g. 1, 21, 78].
  • Some apps focus on physical and mental health during particular life events such as bereavement (Grief: Support for Young People), illness (CaringBridge) or pregnancy (Baby Bump, Mind The Bump).
  • Others focus on women’s health in particular, for example menstruation tracking apps (e.g. Clue), which offer a combination of mood and symptom tracking, analysis and feedback for monitoring both physical and psychological aspects of the monthly cycle
  • Methods:

    Design challenges for mHealth

    User studies and participatory design sessions are well established in HCI and digital media design, in order to identify and cater for user needs [61].
  • It must be emphasized that the participating midwives themselves represented a variety of ethnic groups, including those under discussion, and so their comments could be seen to reflect both professional and personal community knowledge
  • This illustrates the value of eliciting feedback from those operating closely with a target community who can identify assumptions and vulnerabilities in design where access to peer users is not possible.
  • They noted that an app could provide crucial access to younger women whose smartphones are an essential communication tool and to the many for whom admitting struggles with emotional wellbeing is still taboo
  • Results:

    Perinatal depression (PND) is one of the most common psychiatric disorders during pregnancy, affecting up to 15% of women during pregnancy or within one year of giving birth [8, 85].
  • Conclusion:

    The design sessions reveal insights into how an app could address the psychological wellbeing of people whose needs are frequently not met in traditional healthcare paths
  • It shows how even the most well informed designs following user-centred and/or participatory processes may not sufficiently uncover unconscious assumptions and may miss some ethical design considerations.
  • The Wider NetWe have introduced an approach to applying phronesis in mHealth technologies for a more informed design process based on everyday wisdom
  • This is not a new technique for designers, but offers a perspective on how to shape ethical reflection in design.
  • The authors' analysis shows that involving a large number of midwives as well as clinical researchers and medical practitioners produces value ‘conversations’ that result in changes to the ‘voice’ and tone of the app design
Funding
  • Barry is supported by an Irish Research Council postdoctoral fellowship
  • This work is supported in part by Science Foundation Ireland through (Grant 12/CE/I2267) to the Adapt Centre, and a National Institute for Health Research (NIHR) Imperial Biomedical Research Centre award through the Population Health Theme
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