clinical mobile technology

Article: Recommendations For Implementing a Longitudinal Study Using Wearable and Environmental Sensors in a Health Care Organization

This study gives examples for implementing technology-facilitated approaches and provides the following recommendations for conducting such longitudinal, sensor-based research, with both environmental and wearable sensors in a health care setting: pilot test sensors and software early and often; build trust with key stakeholders and with potential participants who may be wary of sensor-based data collection and concerned about privacy; generate excitement for novel, new technology during recruitment; monitor incoming sensor data to troubleshoot sensor issues; and consider the logistical constraints of sensor-based research.

L’Hommedieu M, L’Hommedieu J, Begay C, Schenone A, Dimitropoulou L, Margolin G, Falk T, Ferrara E, Lerman K, Narayanan S. (2019). Lessons Learned: Recommendations For Implementing a Longitudinal Study Using Wearable and Environmental Sensors in a Health Care Organization. JMIR Mhealth Uhealth, 7(12):e13305.

We’re going to be seeing more and more of this type of research in healthcare organisations, which I think is a good thing, given the following caveats (I’m sure that there are many more):

  • We still need to be critical about how sensors record data, what kind of data they record, and what kinds of questions are prioritised with this type of research.
  • Knowing more about how bodies work at the physiological level doesn’t say anything about the social, political, ethical, etc. factors that are responsible for the bigger health issues of our time e.g. chronic diseases of life.
  • Behaviour can be tracked but the underlying beliefs that drive behaviour are still opaque. We need to be careful not to confuse behaviour with reasons for that behaviour.

Using sensors for data collection allows us to overcome the limitations of traditional data collection tools, such as surveys, as sensor data are considered to be more objective and accurate.

The reason I think that sensor-based research is, in general, a good thing is because the questions that you’re likely to ask in these kinds of studies are the same questions that we currently use observation and participant self-report to answer. We know that these forms of data collection are inherently unreliable so it’s interesting to see people trying to address this.

However, even assuming that sensor-based studies are more reliable (and we would first need to ask, reliable against what outcomes?), having more reliable data says little about whether the questions and corresponding data are valid. In other words, we need to be careful that that date being collected is appropriate for answering the types questions we’re asking.

Finally, it stands to reason that once we have the data on the behaviour (the easy part) we still need to do the hard research that gets at the underlying reasons for why people behave in the way that they do. Simply knowing that people tend to do X is only the first step. Understanding why they do X and not Y is another step (possibly determined by interviews for FGDs), and then presumably trying to get them to change their behaviour may be the hardest part of all.

AI clinical

Comment: Sensing behavior.

Wearable technology like smartwatches and the related digital devices that now populate our homes and workplaces are starting to change the face of medicine, as they produce data that help us diagnose health issues, and capabilities to help treat them. On this episode, we look at the rise of personal health informatics and computational approaches to behavioral science, with a special focus on caring for children with severe autism.

Cohen, D. & Goodwin, N. (2019). Sensing Behavior. What’s New podcast.

If I have someone wearing that biosensor and we have 3 minutes of their previous data, 8 out of 10 times that we would predict that they’re going to aggress in the next one minute, they do.

In this conversation Dan Cohen speaks to Mathew Goodwin about using wearable sensors to predict future episodes of aggressive behaviour in children with autism. The AI is picks up physiological variations in the children that are invisible to human observers and uses those changes to make very accurate predictions about the likelihood of an aggresive incident occuring in the next minute. In other words, the sensor being worn by the child is recording changes in their physiology that any human caregiver would never be able to see and then telling a caregiver, “In one minute the child is going to become aggressive.” For caregivers and parents, one minute is a significant amount of time to either prepare for it or to make efforts to de-escalate and buy more time.

And these are not so-called “black box” algorithms; the researchers can interrogate the data and, by eliminating different variables from the analysis, can make fairly strong claims about what physiological features are predictive of aggressive behaviour. Over time, as the sensors become more sophisticated, lighter, and cheaper, we’re going to see everyone wearing sensors of some kind that provide insights into our behaviour.

We all have periods of feeling stressed, angry or sad without really knowing why. While we may never know precisely why, it looks like we may get to a point where we can know something about how. Imagine getting feedback from a wearable saying that, based on a combination of heart rate, blood pressure, pupil dilation, etc., you’re likely to feel angry within the next 30 seconds and that maybe it would be a good idea to step away from whatever you’re doing and take a few deep breaths. Imagine how that might influence your relationship with your spouse, children and co-workers?

Download the episode transcript.

ethics research students teaching

Facebook, friends and students

This is post is the first of what I hope will be several reflections on the softening boundaries between my social and professional lives, and how they influence each other. When I started teaching in the department about 3 years ago, I decided that I wouldn’t accept friend requests on Facebook from any of our students, nor would I send them any. I had a few reasons for this, including the following beliefs:

  • It’d be an invasion of their privacy
  • They may feel an obligation to accept, even if they didn’t want to
  • I didn’t feel comfortable hearing and seeing what they were doing in their private lives
  • I wasn’t sure that I’d be able to remain objective if I grew closer to the students I shared interests with
  • I was trying to keep my professional and private lives separate

Last year I ran a social networking research project in our department, which had students completing assignments within a private social network that I set up using WordPress and Buddypress. I learned a lot through the experience, including the following:

  • Facilitating engagement around professional issues in a social environment is hard
  • Students use (or don’t use) the tools in the way you expect / want them to
  • Most of them only participated in the network for the duration of the assignment, and didn’t go back when it was completed
  • Students shared personal experiences (with me and with each other) in ways that helped me to see more clearly who they really are

The last point was perhaps the lesson that touched me most. Most of our students have a tendency to see us as “just lecturers” and feel that there’s a huge chasm between us and them. To get around this, I often share some of my personal experiences to show that I also struggle to get through the challenges I’m presented with. I try to highlight the fact that as they find some things difficult to overcome, so do I and that the only real differentiator between us is our levels of experience in the various domains of our lives. This has happened most often with students on one of the rural community placements that I supervise. I often spend hours talking to them about some of the issues they’re experiencing, not only on the placement, but also in their personal lives. This has had a profound impact on some of them, as they’ve come to me after graduating and told me how much those social interactions helped shape who they’ve become.

I’m beginning to think that it’s impossible to keep my personal life out of the classroom and in addition, whether that’s something I should even strive for. The end of last year saw me going through an emotional upheaval that was devastating. I was incapable of thinking clearly, let alone teach (thankfully, classes were over for the year) and it was clear that my personal experiences very much affected my professional behaviour. This got me thinking about what our students bring with them into the classroom that we have no idea of, and which has a profound impact on how they’re able to participate in the class. What I’ve learned through this is that my social and professional personas are not only connected, but deeply integrated and to ignore that is to miss out on really understanding myself and my students.

I’ve also been more active on Facebook recently. Over the past month or so, I’ve been friending last years graduates as they prepare for their year of community service in different parts of the country. Not only do I enjoy keeping in touch with them, I try to provide an additional level of support as they’re trying to find their way in their professional lives. This has been an interest of mine since my Masters research looked at how emerging technology could be used to help support students and new graduates, especially in the more rural placements. This is the second year that I’ve been adding our past students to my Facebook friend list, and I often have opportunities to catch up with how they’re getting on, which is great.

This, together with my social networking project, has had me reflecting on whether or not maintaining the “friend barrier” with students on Facebook is actually a good thing. My understanding of what is “personal” and what is “professional” is that they’re blurring together, and I wonder if exploring different aspects of engaging with students on Facebook might be a positive experience for us all. A simple example would be the many opportunities for modeling behaviour. Instead of having a “No Facebook-friending” policy, wouldn’t it be better to tell them that I’m available on Facebook if they’d like to connect? I could tell them that there’d be no pressure to ask or accept and that they wouldn’t be disadvantaged by choosing not to do it (for example, I won’t be giving exam tips on Facebook). I’d also make it clear that for good or bad, I’d be able to see their social activities (as they’d be able to see mine), which may impact on our classroom interactions.

Our 4th year students spend most of the year off campus on clinical placements, and often feel that they’re isolated from social and professional support. I’m thinking of letting them know that if they send me a friend request, I’ll accept it, having first run through the implications of what it’d mean. If you have any thoughts or suggestions, I’d love to hear from you.