Sean A. Munson

University of Washington Seattle | UW · Department of Human Centered Design and Engineering

Background Psychological impacts of hypertension diagnostic testing and new hypertension diagnoses are unclear. Methods BP-CHECK was a randomized diagnostic study conducted in 2017-2019 in an integrated healthcare system. Participants with no hypertension diagnosis or medications and elevated blood pressure (BP) were randomized to one of three dia...

The COVID-19 pandemic resulted in fewer clinic-based blood pressure (BP) measurements and worsening hypertension control, but new opportunities for taking hypertension care out of the office and into patients homes using self-measured BP (SMBP). Methods: We performed a mixed methods study of 6489 patients at Kaiser Permanente Washington with hypert...

Background: Out-of-office blood pressure (BP) measurement is recommended when making new hypertension diagnoses. However, in current practice, hypertension is primarily diagnosed using clinic BP measurements. Objective: To understand patient attitudes about the accuracy and patient-centeredness of different BP measurement and hypertension diagnosti...

Background: Digital mental health interventions, such as 2-way and asynchronous messaging therapy, are a growing part of the mental health care treatment ecosystem, yet little is known about how users engage with these interventions over the course of their treatment journeys. User engagement, or client behaviors and therapeutic relationships that...

YouTube has many features, such as homepage recommendations, that encourage users to explore its vast library of videos. However, when users visit YouTube with a specific intention, e.g., learning how to program in Python, these features to encourage exploration are often distracting. Prior work has innovated ‘commitment interfaces’ that restrict s...

Background: We compared critical flicker frequency (CFF) thresholds obtained using a novel, portable device "Beacon" with thresholds from the commercially available Lafayette Flicker Fusion System (Lafayette-FFS) in patients with cirrhosis. Methods: 153 participants with chronic liver disease underwent CFF testing using Beacon and Lafayette-FFS...

Background Early identification and control of hypertension is critical to reducing cardiovascular disease events and death. U.S. Preventive Services Task Force guidelines recommend health care professionals screen all adults for hypertension, yet 1 in 4 adults with hypertension are unaware of their condition. This gap between guidelines and clinic...

Background The US Preventive Services Task Force recommends measuring blood pressure (BP) outside of clinic/office settings. While various options are available, including home devices, BP kiosks, and 24-h ambulatory BP monitoring (ABPM), understanding patient acceptability and adherence is a critical factor for implementation.Objective To compare...

Goal setting is critical to achieving desired changes in life. Many technologies support defining and tracking progress toward goals, but these are just some parts of the process of setting and achieving goals. People want to set goals that are more complex than the ones supported through technology. Additionally, people use goal-setting technologi...

BACKGROUND Digital mental health interventions such as two-way, asynchronous messaging therapy are a growing part of the mental healthcare treatment ecosystem, yet little is known about how users engage with these interventions over the course of their treatment journeys. Mapping the user experience in digital therapy may be facilitated by integrat...

Objective: This study explored consumers' perspectives on self-monitoring, a common feature in behavioral interventions that helps inform consumers' progress and answer their questions, to learn what outcome metrics matter to consumers and whether self-selection of these metrics leads to greater engagement (i.e., compliance, satisfaction) in self-...

Background: The US Preventive Services Task Force recommends blood pressure (BP) measurements using 24-h ambulatory monitoring (ABPM) or home BP monitoring before making a new hypertension diagnosis. Objective: Compare clinic-, home-, and kiosk-based BP measurement to ABPM for diagnosing hypertension. Design, setting, and participants: Diagnos...

Introduction: The US Preventive Services Task Force recommends out-of-office blood pressure (BP) measurement before making a new hypertension diagnosis and initiating treatment, using 24-hour ambulatory (ABPM) or home BP monitoring. However, this approach is not common. Methods: e-mail-linked surveys were sent to primary care team members (n = 4...

BACKGROUND People often prefer evidence-based psychosocial interventions (EBPIs) for mental health care, but these interventions often remain unavailable to people in non specialty or integrated settings, such as primary care and schools. Previous research has suggested that usability–a concept from human centered design–could support an understand...

Adolescent depression is common; however, over 60% of depressed adolescents do not receive mental health care. Digitally-delivered evidence-based psychosocial interventions (EBPIs) may provide an opportunity to improve access and engagement in mental health care. We present a case study that reviews lessons learned from using the Discover - Design...

Background Developers, designers, and researchers use rapid prototyping methods to project the adoption and acceptability of their health intervention technology (HIT) before the technology becomes mature enough to be deployed. Although these methods are useful for gathering feedback that advances the development of HITs, they rarely provide usable...

The COVID-19 pandemic upended the lives of families with young children as school closures and social distancing requirements left caregivers struggling to facilitate educational experiences, maintain social connections, and ensure financial stability. Considering families' increased reliance on technology to survive, this research documents parent...

As self-tracking has evolved from a niche practice to a mass-market phenomenon, it has become possible to track a broad range of activities and vital parameters over years and decades. This creates both new opportunities for long term research and also illustrates some challenges associated with longitudinal research. We establish characteristics o...

Background Implementation strategies have flourished in an effort to increase integration of research evidence into clinical practice. Most strategies are complex, socially mediated processes. Many are complicated, expensive, and ultimately impractical to deliver in real-world settings. The field lacks methods to assess the extent to which strategi...

Background Many teenagers in the United States experience challenges with symptoms of depression, and they lack adequate resources for accessing in-person mental health care. Involving teens and clinicians in designing technologies that use evidence-based practices that reduce barriers to accessing mental health care is crucial. Interventions based...

BACKGROUND Developers, designers, and researchers use rapid prototyping methods to project the adoption and acceptability of their health intervention technology (HIT) before the technology becomes mature enough to be deployed. Although these methods are useful for gathering feedback that advances the development of HITs, they rarely provide usable...

Personal health informatics continues to grow in both research and practice, revealing many challenges of designing applications that address people's needs in their health, everyday lives, and collaborations with clinicians. Research suggests strategies to address such challenges, but has struggled to translate these strategies into design practic...

Human-computer interaction has a long history of working with marginalized people. We sought to understand how HCI researchers navigate work that engages with marginalized people and considerations researchers might work through to expand benefits and mitigate potential harms. In total, 24 HCI researchers, located primarily in the United States, pa...

Background: Usability - the extent to which an intervention can be used by specified users to achieve specified goals with effectiveness, efficiency, and satisfaction - may be a key determinant of implementation success. However, few instruments have been developed to measure the design quality of complex health interventions (i.e., those with sev...

In the attention economy, video apps employ design mechanisms like autoplay that exploit psychological vulnerabilities to maximize watch time. Consequently, many people feel a lack of agency over their app use, which is linked to negative life effects such as loss of sleep. Prior design research has innovated external mechanisms that police multipl...

Background. Implementation strategies have flourished over the last decade in an effort to increase integration of research evidence into clinical practice. Most strategies are complex, socially-mediated processes. Many are complicated, expensive, and ultimately impractical to deliver in real-world settings. The field lacks methods to assess the ex...

Advancements in evidence-based psychosocial interventions, digital technologies, and implementation strategies (i.e., health services research products) for youth mental health services have yet to yield significant improvement in public health outcomes. Achieving such impact will require that these research products are easy to use, useful, and co...

Context: The US Preventive Services Task Force recommends out-of-office blood pressure (BP) measurement before making a new diagnosis of hypertension, using 24-hour ambulatory (ABPM) or home BP monitoring. However, this approach is not common in routine practice. Objective: To evaluate provider knowledge, beliefs, and practices about BP diagnostic...

BACKGROUND Accounting for how end-users engage with technologies is imperative for designing an efficacious mobile behavioral intervention. OBJECTIVE This mixed-methods analysis examined the translational potential of user-centered design and basic behavioral science to inform the design of a mobile intervention for obesity and binge eating. METH...

Background Accounting for how end users engage with technologies is imperative for designing an efficacious mobile behavioral intervention. Objective This mixed methods analysis examined the translational potential of user-centered design and basic behavioral science to inform the design of a new mobile intervention for obesity and binge eating....

BACKGROUND Many teenagers in the United States experience challenges with symptoms of depression, and they lack adequate resources for accessing in-person mental health care. Involving teens and clinicians in designing technologies that use evidence-based practices that reduce barriers to accessing mental health care is crucial. Interventions based...

Hundreds of popular mobile apps today market their ties to mindfulness. What activities do these apps support and what benefits do they claim? How do mindfulness teachers, as domain experts, view these apps? We first conduct an exploratory review of 370 mindfulness-related apps on Google Play, finding that mindfulness is presented primarily as a to...

Parents and their school-age children can impact one another's sleep. Most sleep-tracking tools, however, are designed for adults and make it difficult for parents and children to track together. To examine how to design a family-centered sleep tracking tool, we designed DreamCatcher. DreamCatcher is an in-home, interactive, shared display that agg...

Mobile mental health interventions have the potential to reduce barriers and increase engagement in psychotherapy. However, most current tools fail to meet evidence-based principles. In this paper, we describe data-driven design implications for translating evidence-based interventions into mobile apps. To develop these design implications, we anal...

Digital psychiatry is a rapidly growing area of research. Mobile assessment, including passive sensing, could improve research into human behavior and may afford opportunities for rapid treatment delivery. However, retention is poor in remote studies of depressed populations in which frequent assessment and passive monitoring are required. To impro...

N-of-1 tools offer the potential to support people in monitoring health and identifying individualized health management strategies. We argue that elicitation of individualized goals and customization of tracking to support those goals are a critical yet under-studied and under-supported aspect of self-tracking. We review examples of self-tracking...

Background Usability – the extent to which an intervention can be used by specified users to achieve specified goals with effectiveness, efficiency, and satisfaction – is a key determinant of implementation success. However, usability is rarely assessed in implementation research and no instruments have been developed to measure the design quality...

Background. Usability – the extent to which an intervention can be used by specified users to achieve specified goals with effectiveness, efficiency, and satisfaction – is a key determinant of implementation success. However, few instruments have been developed to measure the design quality of complex health interventions (i.e., those with several...

Background Usability – the extent to which an intervention can be used by specified users to achieve specified goals with effectiveness, efficiency, and satisfaction – is a key determinant of implementation success. However, usability is rarely assessed in implementation research and no instruments have been developed to measure the design quality...

Background. Usability – the extent to which an intervention can be used by specified users to achieve specified goals with effectiveness, efficiency, and satisfaction – is a key determinant of implementation success. However, few instruments have been developed to measure the design quality of complex health interventions (i.e., those with several...

Background Usability – the extent to which an intervention can be used by specified users to achieve specified goals with effectiveness, efficiency, and satisfaction – is a key determinant of implementation success. However, usability is rarely assessed in implementation research and no instruments have been developed to measure the design quality...

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Background: Innovative approaches are needed to maximize fit between the characteristics of evidence-based practices (EBPs), implementation strategies that support EBP use, and contexts in which EBPs are implemented. Standard approaches to implementation offer few ways to address such issues of fit. We characterized the potential for collaboration...

Collaborations increasingly draw on personal data. We examine personal-data-supported collaborations in a high stakes, high-performance environment: collegiate sports. We conducted 22 interviews with people from four common roles within collegiate sports teams: athletes, sport coaches, athletic trainers, and strength and conditioning coaches. Using...

Although self-tracking offers potential for a more complete, accurate, and longer-term understanding of personal health, many people struggle with or fail to achieve their goals for health-related self-tracking. This paper investigates how to address challenges that result from current self-tracking tools leaving a person's goals for their data uns...

Discussions of online social technologies focus on their negatives in relation to wellbeing, prioritizing offline relationships and reduced screen time. However, many communities depend on online social technologies for building community, gaining social support, and even exploring identity. This makes the use of these technologies crucial for the...

Background: This paper presents the protocol for the National Institute of Mental Health (NIMH)-funded University of Washington's ALACRITY (Advanced Laboratories for Accelerating the Reach and Impact of Treatments for Youth and Adults with Mental Illness) Center (UWAC), which uses human-centered design (HCD) methods to improve the implementation o...

Objective: Technology-enabled services frequently have limited reach and suboptimal engagement when implemented in real-world settings. One reason for these implementation failures is that technology-enabled services are not designed for the users and contexts in which they will be implemented. User-centered design is an approach to designing tech...

Teenagers have unique needs for mental wellbeing that can be supported by interactive technologies. Teens also have valuable input in the design of technology, so designers and researchers must seek new methods for involving them in the design process. We enrolled 23 unacquainted teenagers in an Asynchronous Remote Communities (ARC) study consistin...

Using scientific discoveries to inform design practice is an important, but difficult, objective in HCI. In this paper, we provide an overview of Translational Science in HCI by triangulating literature related to the research-practice gap with interview data from many parties engaged (or not) in translating HCI knowledge. We propose a model for Tr...

Traditionally, many consumer-focused technologies have been designed to maximize user engagement with their products and services. More recently, many technology companies have begun to introduce digital wellbeing features, such as for managing time spent and for encouraging breaks in use. These are in the context of, and likely in response to, ren...

Background: The US Preventive Services Task Force recommends out-of-office blood pressure (BPs) before making a new diagnosis of hypertension, using 24-h ambulatory (ABPM) or home BP monitoring (HBPM), however this is not common in routine clinical practice. Blood Pressure Checks and Diagnosing Hypertension (BP-CHECK) is a randomized controlled di...

Identifying and planning strategies that support a healthy lifestyle or manage a chronic disease often require patient-provider collaboration. For example, people with healthy eating goals often share everyday food, exercise, or sleep data with health coaches or nutritionists to find opportunities for change, and patients with irritable bowel syndr...

The rise of affordable sensors and apps has enabled people to monitor various health indicators via self-tracking. This trend encourages self-experimentation, a subset of self-tracking in which a person systematically explores potential causal relationships to try to answer questions about their health. Although recent research has investigated how...

Background Innovative approaches are needed to maximise the uptake and sustainment of evidence-based practices in a variety of health service contexts. This protocol describes a study that will seek to characterise the potential of one such approach, user-centred design (UCD), which is an emerging field that seeks to ground the design of an innovat...

User-centered design (UCD), a discipline that seeks to ground the design of an innovation in information about the people who will ultimately use that innovation, has great potential to improve the translation of evidence-based practices from behavioral medicine research for implementation in health care settings. UCD is a diverse, innovative field...

User-centered design (UCD), a discipline that seeks to ground the design of an innovation in information about the people who will ultimately use that innovation, has great potential to improve the translation of evidence-based practices from behavioral medicine research for implementation in health care settings. UCD is a diverse, innovative field...

An abundance of digital tools exist for tracking various aspects of one's life, body, health, and activities. These personal informatics (PI) and quantified self (QS) technologies are designed to help users capture, reflect on, and get actionable feedback about personal information. In the past (and still in many cases), the design of such systems...

Critical flicker frequency (CFF) is the minimum frequency at which a flickering light source appears fused to an observer. Measuring CFF can support early diagnosis of minimal hepatic encephalopathy (MHE), a condition affecting up to 80% of people with cirrhosis of the liver. However, adoption of CFF measurement in clinical practice has been hamper...

Self-tracked health data can help people and their health providers understand and manage chronic conditions. This paper examines personal informatics practices and challenges in migraine, a condition characterized by unpredictable, intermittent, and poorly-understood symptoms. To investigate how people with migraine track and use data related to t...

Personal health and wellness technologies can improve people's care at home, connect everyday activities to clinical settings, and allow more efficient use of clinical resources. Recently, the Human-Computer Interaction community has begun to develop tools to improve oral care. In this research, we investigate dental practices and information needs...

Everyday predictive systems typically present point predic­tions, making it hard for people to account for uncertainty when making decisions. Evaluations of uncertainty displays for transit prediction have assessed people’s ability to extract probabilities, but not the quality of their decisions. In a controlled, incentivized experiment, we had sub...

Exercise plans help people implement behavior change. Crowd workers can help create exercise plans for clients, but their work may result in lower quality plans than produced by experts. We built CrowdFit, a tool that provides feedback about compliance with exercise guidelines and leverages strengths of crowdsourcing to create plans made by non-exp...

To successfully function within a team, students must develop a range of skills for communication, organization, and conflict resolution. For students on the autism spectrum, these skills mirror the social, communicative, and cognitive experiences that can often be challenging for these learners. Since instructors and students collaborate using a m...

Background: For many people, tracking health indicators is central to managing a chronic illness. However, previous informatics research has largely viewed tracking as a solitary process that lacks the characteristics essential to tracking in support of chronic illness management. Objective: To inform development of effective technologies that a...

BACKGROUND For many people, tracking health indicators is central to managing a chronic illness. However, previous informatics research has largely viewed tracking as a solitary process that lacks the characteristics essential to tracking in support of chronic illness management. OBJECTIVE To inform development of effective technologies that aid t...

Most health technologies are designed to support people who have already decided to work toward better health. Thus, there remains an opportunity to design technologies to help motivate people who have not yet decided to make a change. Understanding the experiences of people who have already started to make a health behavior change and how they mad...

This forum is dedicated to personal health in all its many facets: decision-making, goal setting, celebration, discovery, reflection, and coordination, among others. We look at innovations in interactive technologies and how they help address current critical healthcare challenges. --Yunan Chen, Editor