The groundbreaking research article, “Designing assisted living technologies ‘in the wild’: preliminary experiences with cultural probe methodology,” published in BMC Medical Research Methodology, offers invaluable insights into developing Assisted Living Technologies (ALTs) that truly meet the diverse needs of older people. Authored by Wherton, Sugarhood, Procter, Rouncefield, Dewsbury, Hinder, and Greenhalgh, this paper details the ATHENE (Assistive Technologies for Healthy Living in Elders: Needs Assessment by Ethnography) project, which aims to illuminate the daily living experiences of older people and facilitate the co-production of effective technologies and services.
The Challenge: Designing ‘In the Wild’ With an aging global population, there’s a growing interest in ALTs like telecare and telehealth to support independence at home and deliver more cost-effective healthcare. However, effective ALT development requires understanding how real people live in their real homes and communities – a process known as designing ‘in the wild’. The home environment is deeply private and sensitive, making a deep understanding of users’ needs, wishes, and routines critical for successful adoption and integration of new technologies.
A Novel Approach: The Home and Life Scrapbook Cultural Probe To address this, the ATHENE project developed and deployed a unique cultural probe tool called the ‘Home and Life Scrapbook’. This methodology, distinct from conventional observational studies, offers a relatively unobtrusive way to gain insight into how technology fits (or doesn’t fit) into domestic settings. Thirty-one participants, aged 60 to 98, with a range of health conditions and social backgrounds, were visited three times in their homes. Following an initial interview, they received the probe materials for a week, including a digital camera and the ‘Home and Life Scrapbook’. The scrapbook contained various open-ended activities designed to capture rich, nuanced data:
- Maps: To illustrate relationships with people, places, and objects.
- Lists: For expressing likes, dislikes, concerns, and comforts.
- Wishes: To identify desired changes or improvements in their lives.
- Body Outline: To indicate symptoms or impairments.
- Home Plan: For mapping room layouts and object usage.
- Diary: To record daily activities and events.
After one week, researchers reviewed these materials with participants, using them to facilitate in-depth discussions and a ‘home tour’.
Key Findings and Insights: The study found that cultural probes were highly effective in collecting visual, narrative, and material data, fostering high levels of engagement in some participants. Discussions about the collected materials (or reasons for non-completion) were crucial for eliciting information relevant to ALT design. Notably, the probes were particularly helpful when communicating with non-English speaking participants through an interpreter, as visual materials provided a more accessible communication channel.
Specific activities yielded profound insights:
- The digital camera was the most commonly used activity, prompting detailed conversations about meaningful aspects of the home, routines, and social encounters. For example, photos taken by a Tamil participant, Thennan, at a community center revealed barriers to computer learning due to existing care demands and family commitments. Another participant, Ravanan, used photos as a memory aid, prompting discussions about his social network that weren’t evident in initial interviews.
- Relationship maps helped participants like Rhoda communicate complex social support networks, highlighting the differentiated roles of family members (e.g., one daughter as main carer, another for social outings) and the symbolic value of places like her front door for social interaction. This revealed sophisticated divisions of labor within families that have significant implications for embedding ALTs.
- The ‘lists’ activity broadened discussions beyond health, showing how issues like financial stress (e.g., mortgage worries for Thennan) overshadowed ALT use, emphasizing the social determinants of health. For Colin, lists revealed concerns about his wife’s dementia, leading to insights about the need for greater personalization of ALTs.
- ‘Wishes’ helped distinguish between what participants needed and what they wanted, revealing factors impacting their quality of life. Bilal, for instance, wished to walk alone outside daily, highlighting the limitations of his indoor-only telecare alarm and the need for ALTs that support activities beyond the home.
- The body outline allowed for sensitive discussions about physical and cognitive issues. Rhoda spontaneously recorded “forgetful sometime,” enabling a discussion about how mild memory lapses and anxiety interacted with her physical limitations, underscoring the complex interplay of sub-clinical conditions. George’s drawing of feeling “tired and worn out” opened up conversations about his low moods and poor sleep, demonstrating the probe’s ability to capture subjective experiences in situ.
- Diaries provided insights into daily routines and their importance for managing chronic illness. Ravanan’s consistent routine for diabetes management, and Rhoda’s need to find activities during the day to avoid unintentional naps, illustrated how lifestyle choices can both accommodate and exacerbate illnesses. Colin’s diary entries detailed incidents with his wife’s nighttime wanderings, a topic he was reluctant to discuss face-to-face, highlighting the value of probes for capturing sensitive events.
Limitations and Future Directions: While highly effective, the study acknowledged that cultural probes may be constrained by participants’ physical, mental, and emotional capacity. Some participants with severe physical or sensory impairments, or those experiencing fatigue or stress, used the probe minimally or not at all. The ‘home plan’ activity also proved too demanding for many. The authors suggest a need for more accessible probe tools, such as shortened versions or electronic devices for those with impairments.
Conclusion: A Powerful Tool for Co-Production This study firmly establishes cultural probes as a useful tool for gaining deep insight into the rhythms, meanings, and social influences within the home. They facilitate communication, allow for reflection, serve as memory aids, and enable ‘cognitive offloading’ of complex information. The methodology supports a co-production approach to ALT development, moving beyond mere technology design to consider broader social determinants of health, cultural embedding of technology, and complex institutional relationships. By capturing small, seemingly idiosyncratic details, cultural probes help researchers ‘zoom out’ to understand meso- and macro-level social structures that shape the experience of illness and aging.
This article is essential reading for anyone involved in the design, development, and implementation of assisted living technologies, offering a pathway to creating solutions that are truly fit-for-purpose and enhance the lives of older adults.
Reference:
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. BMC Medical Research Methodology, 12(1), 188. https://doi.org/10.1186/1471-2288-12-188