Bridging Context and Culture: Designing Cross-Cultural Solutions for Type 2 Diabetes Care in NigeriaCulturally sensitive design is crucial for developing inclusive technologies, particularly in resource-constrained settings. However, such approaches often oversimplify culture and face challenges in cross-cultural transferability. This study addresses these issues by exploring how participatory design can be both culturally grounded and adaptable across subcultures within African communities. We conducted 13 distributed design workshops with 19 participants, including people with Type 2 Diabetes (T2D), caregivers, and pharmacists, from diverse ethnic groups in Port Harcourt, Nigeria. These workshops informed the design of a mobile health prototype featuring interactive flows in Pidgin English, collaborative care tools, peer support groups, and a calorie prediction feature. The prototype was evaluated by 30 participants through think-aloud sessions and interviews. Findings highlight that while some features aligned with local cultural norms, others were less effective across sociocultural boundaries, even within the same city. We offer insights and methodological guidance for developing digital health tools that are locally relevant and regionally adaptable.2025TATim Arueyingho et al.Cognitive Impairment & Neurodiversity (Autism, ADHD, Dyslexia)Developing Countries & HCI for Development (HCI4D)DIS
Integrating Technology into Self-Management Ecosystems: Young Adults with Type 1 Diabetes in the UK using SmartwatchesSelf-managing chronic conditions typically involves a diverse network of individuals and devices, forming a self-management ecosystem. For this ecosystem to be effective, components need to work together cohesively. The rapid advancement of technology means new devices need to be repeatedly integrated into existing self-management ecosystems. To examine this process, we used the case study of young adults with type 1 diabetes (T1D) in the UK who were given a smartwatch. Over six months, interviews and focus groups were performed to explore their smartwatch use alongside T1D management. Thematic analysis highlighted that smartwatches have potential as a display, interface and data source in T1D management, which is of particular importance as artificial intelligence plays a growing role in self-management ecosystems. It also emphasised the need for customisation, flexibility and adaptability, and automation in the design of technology to promote integration into existing self-management ecosystems for both T1D and other chronic conditions.2025SJSam Gordon James et al.University of BristolAI-Assisted Decision-Making & AutomationChronic Disease Self-Management (Diabetes, Hypertension, etc.)Smartwatches & Fitness BandsCHI
Rethinking Lived Experience in Chronic Illness: Navigating Bodily Doubt with Consumer Technology in Atrial Fibrillation Self-CareConsumer technology is increasingly used to support the self-care of atrial fibrillation (AF), a chronic heart condition that affects physical, emotional, and mental health due to its unpredictability, symptoms, and complications. Through interviews with 29 adults self-tracking while living with AF, we found that consumer technology enabled participants to outsource bodily awareness to their 'digitised heart,' facilitating innovative pill-in-pocket interventions and empowering negotiation in shared decision-making. Drawing on phenomenology, we introduce 'Bodily Doubt' to explain how uncertainty about the body shapes the use of technology in chronic illness and how the use of technology influences uncertainty. Technology mediates 'Bodily Doubt' both by providing reassurance and exacerbating it, particularly when technology fails to adapt to disease progression. Our findings have implications for understanding how technology influences the lived experience of illness, challenging experiential concepts of lived experience in self-tracking and design that foregrounds the experience of the lived body.2025RKRachel Keys et al.University of BristolMental Health Apps & Online Support CommunitiesChronic Disease Self-Management (Diabetes, Hypertension, etc.)CHI
“I think it saved me. I think it saved my heart”: The Complex Journey From Self-Tracking With Wearables To Diagnosis Despite their nonclinical origins, wearables are emerging as valuable tools in supporting the diagnosis of cardiovascular disease, one of the leading causes of death worldwide. Diagnostic data once only available via a cardiologist is now available to consumers simply by wearing a smartwatch, so understanding how smartwatches currently support diagnosis is important for healthcare providers and for the designers of increasingly sophisticated personal informatics technology. We conducted a qualitative study comprising interviews and analysis of posts on an online community of accounts of smartwatch assisted cardiac diagnosis. Our findings reveal how smartwatches bridge a current gap in clinical diagnostic modalities, facilitating a diagnostic journey instigated and shaped by the interplay of self-collected data, bodily self-awareness, and increasing clinical acceptance. These insights focus attention on the consequences of the democratisation of health data, with ethical and design implications for health providers, consumer electronic companies, and third-party application designers.2024RKRachel Keys et al.University of BristolTelemedicine & Remote Patient MonitoringSmartwatches & Fitness BandsBiosensors & Physiological MonitoringCHI
Using and Appropriating Technology to Support The Menopause Journey in the UKThe menopause transition has a direct impact on half of the global population, yet it has continued to be a stigmatised topic with limited focus on supporting it with technology. Whilst attention being given to menopause in HCI may be new, people experiencing it is not and people have adopted, adapted and appropriated technologies to support their menopause journey. In this questionnaire and interview study, we examine how people in the UK are using (and not using) existing general and menopause-specific technology to support themselves through the transition. Despite limited menopause-specific technologies available, participants have found novel uses of technologies such as social media and smartwatches for 1) connecting and sharing, 2) information seeking, 3) tracking and reflecting, and 4) self-care. This work contributes design considerations for menopause specific technologies, and design opportunities and challenges for technologies that can be appropriated to support menopause.2024EBEmily Lopez Burst et al.University of BristolAging-Friendly Technology DesignCHI
Explanation before Adoption: Supporting Informed Consent for Complex Machine Learning and IoT Health PlatformsExplaining health technology platforms to non-technical members of the public is an important part of the process of informed consent. Complex technology platforms that deal with safety-critical areas are particularly challenging, often operating within private domains (e.g. health services within the home) and used by individuals with various understandings of hardware, software, and algorithmic design. Through two studies, the first an interview and the second an observational study, we questioned how experts (e.g. those who designed, built, and installed a technology platform) supported provision of informed consent by participants. We identify a wide range of tools, techniques, and adaptations used by experts to explain the complex SPHERE sensor-based home health platform, provide implications for the design of tools to aid explanations, suggest opportunities for interactive explanations, present the range of information needed, and indicate future research possibilities in communicating technology platforms.2023RERachel Hahn et al.Health and AICSCW
Independence for Whom? Critical Discourse Analysis of the Onboarding of a Home Health Monitoring System for Older Adult Care Home health monitoring systems (HHMS) are presented as a cost-effective solution that will assist with collaborative care of older adults. However, instead of care recipients feeling like collaborators, such systems often disempower them. In this paper, we examine the dissemination, onboarding, and initial use of an HHMS to see how the discourse used by developers and participants affects users’ collaborative care efforts. We found that the textual information provided often contrasted with how our participants managed their care. Instead of providing participants with ‘independence,’ ‘safety,’ and ‘peace of mind,’ care recipients were placed in a more dependent, less proactive role, and care providers were pressured to take on more responsibilities. We position HHMS, as they are currently marketed and onboarded, as normalizing pseudo-institutionalization. As an alternative we advocate that the discourse and design of such systems should reflect and re-enforce the varied roles care recipients take in managing their care.2023ECElaine Czech et al.University of BristolElderly Care & Dementia SupportAging-in-Place Assistance SystemsCHI
The Shifting Sands of Labour: Changes in Shared Care Work with a Smart Home Health SystemWhilst the use of smart home systems has shown promise in recent years supporting older people's activities at home, there is more evidence needed to understand how these systems impact the type and the amount of shared care in the home. It is important to understand care recipients and caregivers' labour is changed with the introduction of a smart home system to efficiently and effectively support an increasingly aging population with technology. Five older households (8 participants) were interviewed before, immediately after and three months after receiving a Smart Home Health System (SHHS). We provide an identification and documentation of critical incidents and barriers that increased inter-household care work and prevented the SHHS from being successfully accepted within homes. Findings are framed within the growing body of work on smart homes for health and care, and we provide implications for designing future systems for shared home care needs.2023ESEwan Soubutts et al.University of BristolAging-in-Place Assistance SystemsCHI
Social Virtual Reality as a Mental Health Tool: How People Use VRChat to Support Social Connectedness and WellbeingSocial virtual reality (VR) platforms have increased in popularity with many people turning to these platforms to experience social connection, including a rapid influx of users during the COVID-19 pandemic. However, there is limited understanding of how people appropriate and use emerging social VR applications to actively support their mental health and wellbeing in daily life. Through an online questionnaire and exploratory interviews conducted within the social VR app VRChat during the COVID-19 pandemic, we document how social VR is being used explicitly as a mental health support tool. Participants reported positive wellbeing benefits, mostly attributed to the anonymity provided by avatars and perceived safety within digital worlds and communities of practice. We also report how people use social VR to practice social interaction, reduce negative thoughts and form strong social bonds and connections with others.2023MDMairi Therese Deighan et al.University of BristolSocial & Collaborative VRMental Health Apps & Online Support CommunitiesCHI
Chronic Care in a Life Transition: Challenges and Opportunities for Artificial Intelligence to Support Young Adults with Type 1 Diabetes Moving to UniversitySelf-managing a chronic condition involves adapting management strategies to life's continual change. Among these changes, moments of significant life transition can render routine self-management practices obsolete without significant modification to the new context. In this study, we examine one significant life transition for young adults living with Type 1 Diabetes, the move from home to university, to understand how near future AI-enhanced technologies might provide opportunities and challenges for supporting care. From interviews with 24 students in the UK who had moved away from their childhood homes, we used sensemaking literature to frame the process of initial disruption to the rebuilding of self-care practices around a new lifestyle and support networks. By studying a significant life transition, we uncover implications for the design of T1D technology, particularly closed-loop systems, through AI enhancements and human-centred design approaches, then extrapolate for other significant life transitions and chronic conditions.2023SJSam James et al.University of BristolChronic Disease Self-Management (Diabetes, Hypertension, etc.)CHI
Digital Mental Health and Social Connectedness: Experiences of Women from Refugee BackgroundsA detailed understanding of the mental health needs of people from refugee backgrounds is important for the design of inclusive mental health technologies and services. We present a qualitative account of the digital mental health experiences of women from refugee backgrounds. Working with community members and community workers of a charitable organisation for refugee women in the UK, we identify social and structural challenges, including loneliness and access to mental health technologies. Nonetheless, participants’ accounts document their collective agency in addressing these challenges and supporting social connectedness and personal wellbeing in daily life: participants reported taking part in community activities as volunteers, sharing technological expertise, and using a wide range of non-mental health-focused technologies to support their mental health, from playing games to using religious apps. Our findings suggest that, rather than focusing only on self-help and self-care, research also needs to leverage community-driven approaches to foster social mental health experiences, from altruism to connectedness and belonging.2022AAAmid Ayobi et al.Mental Health; Mental HealthCSCW
Aging in Place Together: The Journey Towards Adoption and Acceptance of Stairlifts in Multi-Resident HomesStairlifts are a widely-used technology in the home that help people with mobility issues to go up and down stairs. However, it is unclear how stairlifts are experienced by all household members and what this understanding implies for home healthcare technologies. We investigated the impact of stairlift installations on older adults' households through a qualitative study investigating the lived experience of the adoption and acceptance of this technology. Interviews and focus groups with primary users, household residents and service providers showed how the wider household identify misalignments between simplified stairlift installation models from service providers and describe a more complex, nuanced emotional journey which involves decision making, conflict and trauma and catharsis and independence. Findings provide transferrable outcomes for the smart home domain by highlighting the multi-resident home, the emotional intrusiveness of home healthcare technologies and the diversity that comes with providing care, unique to every household.2021ESEwan Soubutts et al.Aging with TechnologyCSCW
Co-Designing Personal Health? Multidisciplinary Benefits and Challenges in Informing Diabetes Self-Care TechnologiesCo-design is a widely applied design process with well-documented benefits, including mutual learning and collective creativity. However, the real-world challenges of conducting multidisciplinary co-design research to inform the design of self-care technologies are not well established. We provide a qualitative account of a multidisciplinary project that aimed to co-design machine learning applications for Type 1 Diabetes (T1D) self-management. Through retrospective interviews, we identify not only perceived social, technological and strategic benefits of co-design but also organisational, translational and pragmatic design challenges: participants with T1D experienced difficulties in co-designing systems that met their individual self-care needs as part of group design activities; HCI and AI researchers described challenges collaborating to apply co-design outcomes to data-driven ML work; and industry collaborators highlighted academic data sharing regulations as cross-organisational challenges that can impede co-design efforts. Based on this understanding, we discuss opportunities for supporting multidisciplinary collaborations and aligning individual health needs with collaborative co-design activities.2021AAAmid Ayobi et al.Personal and Mental HealthCSCW
Designing Visual Cards for Digital Mental Health Research with Ethnic MinoritiesGaining an understanding of people’s diverse mental health needs is essential for informing the design of inclusive mental health technologies. However, conversations about mental health experiences can be challenging for both researchers and participants. We present the design of visual cards that illustrate an inclusive mental health concept to support researchers and participants in understanding and sharing mental health experiences. We illustrate the iterative design of the visual cards with our reflections and feedback from ethnically diverse participants. We found that designing the visual cards fostered insightful reflections within the design team regarding the roles of identity, gender, and ethnicity in designing culturally sensitive content and research. Participants from minority ethnic backgrounds valued the illustrative elements of the visual cards and highlighted the importance of supporting different languages and visual cultures. We discuss use cases for the visual cards and implications for designing culturally sensitive mental health technologies.2021AAAmid Ayobi et al.Mental Health Apps & Online Support CommunitiesInclusive DesignGender & Race Issues in HCIDIS
Social, Cultural and Systematic Frustrations Motivating the Formation of a DIY Hearing Loss Hacking CommunityResearch on attitudes to assistive technology (AT) has shown both the positive and negative impact of these technologies on quality of life. Building on this research, we examine the sociocultural and technological frustrations with hearing loss (HL) technologies that motivate personal approaches to solving these issues. Drawing on meet-up observations and contextual interview data, we detail participants' experiences of and attitudes towards hearing AT that influences hacking hearing loss. Hearing AT is misunderstood as a solution to the impairment, influencing one-to-one interactions, cultural norms, and systematic frustrations. Participants' exasperation with the slow development of top-down solutions has led some members to design and develop their own personalised solutions. Beyond capturing a segment of the growing DIY health and wellbeing phenomenon, our findings extend beyond implications for design to present recommendations for the hearing loss industry, policy makers, and importantly, for researchers engaging with grassroots DIY health movements.2019AOAisling Ann O'Kane et al.University of BristolDeaf & Hard-of-Hearing Support (Captions, Sign Language, Vibration)Aging-Friendly Technology DesignUniversal & Inclusive DesignCHI