Insight researcher Dr Alison Keogh explains why a better understanding of people is essential for digital health devices to be effective.

Dr Alison Keogh is a postdoctoral researcher at Insight, the Science Foundation Ireland research centre for data analytics. She is currently based at University College Dublin, where she completed a degree in physiotherapy, and she also holds a master’s in sport science and exercise medicine.

After a few years of clinical work, Keogh returned to academia to complete a PhD in the area of behaviour change. Human behaviour is her focus now, as she works with teams building digital health sensors. Keogh’s role in the future of digitised healthcare is to discover how users will best respond to, and adopt the technology that’s made for them. To support this postdoctoral research, she is also studying for a higher diploma in data analytics at National College of Ireland.

‘It goes without saying that for something to be used and implemented it has to work. But this shouldn’t be at the cost of understanding the human side’
^{– DR ALISON KEOGH}

What inspired you to become a researcher?

I guess my spark started during my MSc. Although it was primarily a taught MSc, there was a research component to it. My supervisor was Dr Bernard Donne, who was hugely experienced and didn’t mince his words when it came to ensuring that we all understood the importance of rigour and integrity when it came to research and data collection.

At the time, I was focused on doing my best in the course. But after completing it and entering clinical practice, I realised that I had loved the experience of designing a study and finding out new things.

Clinical work showed me that lifestyle interventions and understanding people’s behaviour was critical for their long-term health, and so when I saw a PhD advertising a project along these lines, I jumped at the chance.

Can you tell us about the research you’re currently working on?

I’m part of the sensing and actuation strand of research led by Prof Brian Caulfield. Our research team consists of people from clinical, engineering and data science backgrounds, and our focus is on health and human performance.

Specifically, we look to utilise sensing platforms, data, signal processing and other digital strategies to improve the design of research involving and understanding human behaviour. This can be anything from designing applications to capture health data, using wearable sensors to monitor movement and behaviour in clinical cohorts, using digital tools to support rehabilitation following injury and monitoring wellbeing.

My own research at the moment focuses on the human factors associated with this work. I explore the usability and acceptability of digital devices and platforms in a variety of cohorts, from healthy adults to clinical patients to researchers themselves.

The main project I’m working on is called Mobilise-D, which aims to develop digital biomarkers of real-world walking. In other words, it looks to be able to predict health outcomes by measuring how people move in their normal environment. I am investigating whether wearable devices are acceptable to clinical cohorts, what we know about this topic already, how researchers implement devices into study designs and how important mobility is to the patients themselves.

In your opinion, why is your research important?

There can be a big difference between how someone moves and behaves in a one-off clinic appointment every few months, and how they behave at home. Digital devices offer us access to people’s lives, movement patterns and real-world health status that we just never had before.

However, we need to make sure that patients are comfortable with the device or tool that they are being asked to use or wear. We need to know if it’s comfortable, if it impacts their daily activities, whether there are any privacy concerns associated with its use or whether they find it difficult to use.

Although these are simple questions, if we don’t ask them the risk is that patients won’t use the tool or device. If they aren’t used then researchers, clinicians and patients won’t get the benefit of their data and insights. So it’s important that whatever we implement or design fits seamlessly into patient’s lives and that we assess this.

What are some of the biggest challenges you face as a usability researcher?

The domain of digital health is still so novel and new. I think because of that, it has not always been obvious how and where usability research fits into the digital sphere. We can be so focused on the idea, the technology, the data, its accuracy, what can be measured, and what it might mean, that it can be easy to forget about the end user and their needs.

It’s only in recent years that it’s become clear how important multi-disciplinary research is in order to help this area reach its true potential. So there is a little bit of catching up to do!

Are there any common misconceptions about usability research?

I think it’s often taken for granted that patients will use and engage with whatever they are given. In fact, there is a real lack of research documenting usability research across a range of devices and cohorts.

It is also perceived as ‘soft’ research in that it is something that is simple and so it can be done at a later point in time, because the data is more important. Obviously, it goes without saying that for something to be used and implemented it has to work. But this shouldn’t be at the cost of understanding the human side.

Put bluntly, the best-performing device or app in the world won’t be worn or used if it is uncomfortable or confusing to use. So really, it’s important to adopt a user-centred design process from the start, and to continue it along the entire journey of development and implementation.

What are some of the areas of research you’d like to see tackled in the years ahead?

I think the potential to merge digital tools and behaviour change theory is massive. We are only starting to see that come into the research at the moment.

Typically, you see behavioural interventions that utilise devices that have already been designed, or alternatively you see devices being designed that fail to consider the theoretical aspects and components that should be integrated into their design. Merging the two areas concurrently offers huge potential for so many areas of healthcare. In particular, if theoretical components can be personalised to individuals’ needs within the context of digital devices, then I think we may see some exciting changes take place.