Outline
Client
The Care@Home group is a three-year, EU-funded project at the Man Machine Interaction unit at the TU Delft working to extend independent home living among the Dutch elderly.
Research Impact
- Refined general to user-specific questions to help product development and strategy
- Identified two pilot personas to help with design guidelines for future intervention for the elderly and care workers
- Identified two product and service business opportunities from the two pilot personas
- Established a cross-disciplinary institutional partnership between the VU Amsterdam and TU Delft
Timeline and Team Composition
- Nine months end-to-end of which two months were the research period
- The Care@Home group consisted of a Principal Investigator, Dr. Nick Guldemond, and three Ph.D. candidates working on home alarms and related devices. One of which is the project manager. I was an external volunteer/consultant.
🚴🏼♀️ Step 1: Research Starting Point
Client: (Product Specific and a Discovery Question)
- How can we harmonise technology to assist other communities of support?
- What are the needs of the elderly unmet by technology?
- What are the lifestyle patterns of the elderly?
My Questions: (Product Agnostic)
I included a broader range of questions to understand the target groups and their environment.
- What are the gaps in our understanding of independent living seniors?
- How might we holistically understand the health ecosystem experience of seniors?
👨👩👧👦 Step 2: Method and Recruitment
Given that the TUDelft cohort has mainly used focused group discussion and surveys, I wanted to introduce the ethnographic approach to the research. This includes as much as possible observation research at home and eliciting context in interviews.
The ideal scenario is to be able to observe people in their homes or workplaces.
- On-site: Sara, 70-plus senior receiving treatment at home
However, we were unable to gain access to shadow a care worker while at work.
- Contextual Interview: Rose, 30-plus person working as a cleaner and general caregiver, studying to get her medical caregiver certificate
Recruitment: Siska, one of the TU Delft Ph.D. candidates, tapped their existing senior networks to recruit for the study. Given her Ph.D. research load, she was only able to recruit two participants within a two-month period.
Despite the limited number of participants in the study, I use these two in-depth encounters to create pilot personas and mapping of the Dutch health care home industry.
🧓🏾 Step 3: Senior Pilot Persona: Sara, 70-plus senior-at-home receiving treatment
A pilot persona is appropriate for limited interviews. In this case, single case scenarios. Given the limitations of the context, an initial needs analysis remains valid. The findings are subject to further verification including secondary literature reviews. My previous knowledge of health care research show consistency with these results.
Main Task or Need:
To be able to occasionally do things but taking into consideration her mobility issues and personal preferences in social activities
Desired Outcomes
- To have planned social interaction on a regular basis outside of the home
- To allow for a selected variety of leisure activities at home and outside
Expected Knowledge
- She knows what she wants and knows where to find the information
- She has family and community members around her.
Missing Knowledge
- She is not updated with the current social activities available to her.
- She doesn’t know if a social activity accommodates her special mobility needs.
- She doesn’t have anyone, aside from her housekeeper, who can drive and take her to an event.
State of Mind
- Restless
- Indifference
- Cynical
💡Step 3a: Findings and Impact
Network thinking is similar to the ecosystem approach. That is, the device is embedded in a wider network of people, systems, and objects with nodes that switch between humans and machines. It is important to enlarge our perspective beyond a human-centred design.
Key Finding
Our home visit uncovered human connection and interaction as a requirement in the home care device ecosystem.
Other Results*
- Debunking assumption: Having a family does not mean support; any familial support cannot be automatically assumed
- Debunking conceptual assumption: Dual concepts such as dependence/independence and patient/person are contextual, dynamic, and non-permanent states for seniors
- Telephone and email are artefacts from their generation but are currently a source of human connection and assistance for Sara and would explain her preference for its continued use.
Gaps and Opportunities
- Designing product use and service integrated with human connection
- New devices and technology can be used with ample human training that doubles as connection and social support
Learning: Material prompts open the interview toward difficult topics like rejection and isolation.
*Note
More interviews and observations would cross-check these findings
🔎 Step 3b: Refining the Research Questions for Designers
It is fundamental to restate the general research questions into more specific questions to hone into our users’ needs. These questions can also be used to identify specific problem areas such as where in the system can people quickly solve the problem or where can devices or impersonal technology can replace rote tasks.
See all the questions we started with here.
From “what are the needs of the elderly unmet by technology?” into:
- How can we integrate human connection within the digital devices ecosystem to combat isolated seniors?
- How can we design digital devices that include in-person human interaction for at-home seniors?
🛠️ Step 3c: Design Principles for Seniors like Sara
Network thinking helps to think of interventions as nodes that switch between states rather than as static positions. We can use these dynamic switching to develop our product and service metrics and interventions.
- Digital and non-digital integration
- Designing for dynamic switching between dual states: e.g. independent/dependence or patient/person
- Designing for both patients and persons
👩🏻 Step 4: Care Worker Pilot Persona: Rose, 30-something, cleaner and general care worker for seniors at home
Since we are unable to shadow Rose in the course of her work, a contextual inquiry is a good proxy. From her interview, we are able to reconstruct one aspect of the health care industry - the low status and rote tasks (’dirty work’) necessary for in-home care. Further investigation would show variations of work within their sector and provide holistic and detailed needs and challenges.
Main Task or Need
To go to a client’s house on time and do household chores or whatever is requested - from cleaning, cooking, or accompanying to the doctor
Desired Outcomes
- Overview of her weekly schedule so she can feel in control and plan her personal activities
- Reduce embarrassment, social awkwardness, and conflict through quick identity verification at the client’s doorstep or even prior to that
Expected Knowledge
- She knows her clients. Clients know her.
- She is trustworthy and feels safe with her clients.
Missing Knowledge
- She does not have control over her schedule.
- She can be quickly re-assigned to new clients at the last minute.
- She does not know the other workers who come before or after her.
State of Mind
- Uncertain
- Anxious
- Time-Conscious
💡 Step 4a: Findings and Impact
The key finding here is only one aspect of numerous tasks that care workers encounter in their work. For Rose who is at the bottom rung of the care industry, her problem of being seen as a legitimate professional is critical. A greater number of informants would later show if this can be prioritised for intervention.
Key Finding:
The lack of identity verification and mistrust is an outcome of a fragmented home care ecosystem.
Other Results:
- A low-ranked home worker employed by a small business has no overview or control of her weekly schedule.
- The fragmented care diminishes the trustworthiness between client and worker.
- The lack of identity verification results in fear and triggering of deep racial stereotypes and conflict between clients and workers.
Gaps and Opportunities
- Identity verification integrated with business processing and scheduling software for workers and business owners
- Identity verification system for clients
Learning: Trauma interview training is recommended for unexpected interview situations.
🔎 Step 4b: Refining the Research Question for Designers
It is fundamental to restate the general research questions into more specific questions to hone into our users’ needs. In this case, our users are the service providers. These questions can also be used to identify service design issues and interventions including third-party contractors.
The critical question for care workers was, “how can we harmonise technology to assist with communities of support?“
After the interview analysis, we can formulate more specific questions for follow-up:
- What are the existing but affordable platforms that can institute trust between clients and rotating workers?
- How can we create a singular and integrated support experience from the client and worker perspective?
- What are the existing trauma or emotional support networks available for contractors? If none, how can we create it?
🛠️ Step 4c: Design Principles for Care Workers like Rose
We can use these user or customer-led concepts to develop our product and service metrics and interventions. Can we simply use a simple workaround like informal social groups for support? A WhatsApp group? Or do they need more policy intervention?
- Control and transparency in the intervention
- Social and emotional support for workers
- Trust building between workers and clients
🧭 Step 5: Research Impact
The findings identified a research roadmap to uncover new business and product use opportunities for the product, customer support, and UX teams. Depending on who the audience will be for the insights, selected insights can be further expanded during the presentation.
Some directions to start with:
Investigate other opportunities within the Dutch home health care ecosystem
- Goal: Identify gaps and other tasks from other types of service workers
- Recruit: Business owners, food service workers, delivery, nurses, medical caregivers, volunteer networks
- Methods: Work shadowing, contextual interviews, short survey to identify main job problems
Identify workarounds by the support network for intervention
- Goal: Identify the gaps and opportunities of other support workers especially low to minimum wage
- Recruit: Nurses, health care students or in training, cleaners
- Methods: Critical task analysis, study training manuals, collect relevant online messages, attend social gatherings
Usability testing and validation of various devices for home health care tasks, including SmartTV
- Goals: Identify which tasks are appropriate for which device; clarify the role and function of SmartTV; singular client service experience
- Recruit: people with SmartTV, people about to buy new TV or monitor, seniors with TV and multiple devices, impaired seniors who own at least one or two devices or who require assistance, hospitals who use SmartTV for operations
- Methods: A/B test, usability testing, Jobs to be Done
🤝Step 6: Partnership
When I began the research, the project was set to finish. To continue the gains from this research, I believed that the impact would be greater if there was an institutional partnership between social scientists, humanities scholars, and engineers. Or at least, some knowledge of interested parties across different disciplines to collaborate on new funding proposals for joint health care research and device development.
Graduate research to continue the work
The goal is to recruit full-time graduate students to undertake applied health care research under a hybrid supervision arrangement that benefits the two institutions.
Inhabiting an intermediary role aside from research
I initiated contact between the VU Amsterdam Anthropology and the Culture Studies departments to work with the TU Delft health device and home care research team.
Impact: The group was able to recruit one Master’s level student to do research.
Training non-specialists
The project coordinator was pleasantly surprised with the results from the two interviews that he asked me to give a one-day seminar for engineers on how to do ethnographic interviews.
Postscript
Since this project had no formal affiliation with my then home university, Vrije Universiteit Amsterdam, a formal report was not necessary. I decided to document the study informally to apply anthropology in the design context and grow my personal knowledge of the Dutch home health care crisis.
While there was no final report, here are some reference materials:
To view the other EU-funded partners, visit Care@Home.
Here’s the journal article of the TU Delft’s Care@Home SmartTV study.
