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Metadata of the chapter that will be visualized in SpringerLink Book Title Human Aspects of IT for the Aged Population. Supporting Everyday Life Activities Series Title Chapter Title Visualizing Wellness: The Myant Skiin System Connected Life App

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  • SUNY Polytechnic Institute, Utica New York

Abstract

This paper presents a design study of the visualization interface to the Myant Skiin Connected Life App (Skiin), a family informatics application which will connect family members, friends, and caregivers, by engaging them together and enabling health and wellness related data sharing and support. It is based on Myant’s highly accurate intelligent textiles garments which collect activity and related biomechanical data through knitted sensors on the garment. Our design seeks to deliver a seamless user experience between this complex of technologies through effective data presentation, visualization, and tool tips. One of Skiin’s differentiators is the provision of a communication overlay (the Aura) which cues users to view metrics data and engage in dialogue around its meaning. We undertook a comprehensive literature review and examination of related work that included personal informatics, mHealth applications, and family informatics – motivation and social communication, wellness standards for older adults, technology adoption by older adults, effective design, and visualization strategies to support aging individuals, their family, friends, and support team, and issues of privacy. We used iterative prototyping to build and revise the visualization interface. We discuss our visualization methods, detail the resulting Skiin application, our usability testing strategy which combines personas, Talk Aloud and SUS approaches, research outcomes, and next steps.
Metadata of the chapter that will be visualized in
SpringerLink
Book Title Human Aspects of IT for the Aged Population. Supporting Everyday Life Activities
Series Title
Chapter Title Visualizing Wellness: The Myant Skiin System Connected Life App
Copyright Year 2021
Copyright HolderName Springer Nature Switzerland AG
Corresponding Author Family Name Diamond
Particle
Given Name Sara
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Organization OCAD University
Address 100 McCaul Street, Toronto, ON, M5T 1W1, Canada
Email sdiamond@ocadu.ca
Author Family Name Hussain
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Given Name Ajaz
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Organization OCAD University
Address 100 McCaul Street, Toronto, ON, M5T 1W1, Canada
Email
Author Family Name Scott
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Given Name Renn
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Organization Myant Inc
Address 100 Ronson Drive, Etobicoke, ON, M9W 1B6, Canada
Email
Author Family Name Basu
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Given Name Rittika
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Organization OCAD University
Address 100 McCaul Street, Toronto, ON, M5T 1W1, Canada
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Author Family Name Cao
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Given Name Shunrong
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Organization OCAD University
Address 100 McCaul Street, Toronto, ON, M5T 1W1, Canada
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Author Family Name Laroia
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Given Name Manisha
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Organization OCAD University
Address 100 McCaul Street, Toronto, ON, M5T 1W1, Canada
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Author Family Name Adnani
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Given Name Veda
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Organization Myant Inc
Address 100 Ronson Drive, Etobicoke, ON, M9W 1B6, Canada
Email
Abstract This paper presents a design study of the visualization interface to the Myant Skiin Connected Life App
(Skiin), a family informatics application which will connect family members, friends, and caregivers, by
engaging them together and enabling health and wellness related data sharing and support. It is based on
Myant’s highly accurate intelligent textiles garments which collect activity and related biomechanical data
through knitted sensors on the garment. Our design seeks to deliver a seamless user experience between
this complex of technologies through effective data presentation, visualization, and tool tips. One of
Skiin’s differentiators is the provision of a communication overlay (the Aura) which cues users to view
metrics data and engage in dialogue around its meaning. We undertook a comprehensive literature review
and examination of related work that included personal informatics, mHealth applications, and family
informatics – motivation and social communication, wellness standards for older adults, technology
adoption by older adults, effective design, and visualization strategies to support aging individuals, their
family, friends, and support team, and issues of privacy. We used iterative prototyping to build and revise
the visualization interface. We discuss our visualization methods, detail the resulting Skiin application, our
usability testing strategy which combines personas, Talk Aloud and SUS approaches, research outcomes,
and next steps.
Keywords
(separated by '-')
Data visualization - Visual analytics - Wearable technologies - Personal informatics - Family informatics -
Seniors informatics - mHealth
Visualizing Wellness: The Myant Skiin System
Connected Life App
Sara Diamond1(B), Ajaz Hussain1, Renn Scott2, Rittika Basu1, Shunrong Cao1,
Manisha Laroia1, and Veda Adnani2
1OCAD University, 100 McCaul Street, Toronto, ON M5T 1W1, Canada
sdiamond@ocadu.ca
2Myant Inc, 100 Ronson Drive, Etobicoke, ON M9W 1B6, Canada
Abstract. This paper presents a design study of the visualization interface to
the Myant Skiin Connected Life App (Skiin), a family informatics application
which will connect family members, friends, and caregivers, by engaging them
together and enabling health and wellness related data sharing and support. It
AQ1
is based on Myant’s highly accurate intelligent textiles garments which collect
activity and related biomechanical data through knitted sensors on the garment.
Our design seeks to deliver a seamless user experience between this complex
of technologies through effective data presentation, visualization, and tool tips.
One of Skiin’s differentiators is the provision of a communication overlay (the
Aura) which cues users to view metrics data and engage in dialogue around its
meaning. We undertook a comprehensive literature review and examination of
related work that included personal informatics, mHealth applications, and family
informatics – motivation and social communication, wellness standards for older
adults, technology adoption by older adults, effective design, and visualization
strategies to support aging individuals, their family, friends, and support team,
and issues of privacy. We used iterative prototyping to build and revise the visual-
ization interface. We discuss our visualization methods, detail the resulting Skiin
application, our usability testing strategy which combines personas, Talk Aloud
and SUS approaches, research outcomes, and next steps.
Keywords: Data visualization ·Visual analytics ·Wearable technologies ·
Personal informatics ·Family informatics ·Seniors informatics ·mHealth
1 Introduction
The Myant Skiin Connected Life App (Skiin) [1] is a family informatics application
which will connect family members, friends, and caregivers, by engaging them together
and enabling health and wellness related data sharing and support. Skiin differs from
products such as Cocoon [2], the Alexa Care Hub [3], or the Medical Guardian smart
watch app [4], or our previous Care and Condition Monitor [5] as it is based on Myant’s
highly accurate intelligent textiles garments which collect activity and related biome-
chanical data through knitted sensors on the garment. Data are transferred from the
© Springer Nature Switzerland AG 2021
Q. Gao and J. Zhou (Eds.): HCII 2021, LNCS 12787, pp. 1–17, 2021.
https://doi.org/10.1007/978-3-030-78111-8_16
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2 S. Diamond et al.
garment pod to the mobile Skiin app via Bluetooth. Skiin began as a family informat-
ics tool, intended to facilitate wellness initiatives and health monitoring for families,
close friends, and caregivers. Myant has recently focused application development on
senior engagement and care, recognizing the accelerating demand for seniors’ health
applications and older adults’ isolation and need for health support that the COVID-19
pandemic has amplified.
Our design seeks to deliver a seamless user experience between this complex of
technologies through effective data presentation, visualization, and tool tips. One of
Skiin’s differentiators is the provision of a communication overlay (the Aura) which cues
users to view metrics data and engage in dialogue around its meaning. Data visualization
is one of the core strategies that health and wellness applications use to allow individuals
to manage, analyze and share their data, including for senior users, “For older adults,
this has the potential of bridging the gap between the abstract collection of data and the
tangible representation of integrated wellness” [6, pg. 923].
2 Related Work
2.1 Wellness and mHealth Applications, Family Informatics
The use of personal informatics technologies has grown significantly in the last decade.
Rooksby et al. [7] describe the personal informatics context as, “lived informatics”, and
emphasize the ephemeral emotional qualities of personal data collection and sharing,
including pleasure and sociality, enhanced self-esteem, and self-image. They recognize
that people collect data across multiple platforms that need integration. Many studies
indicate the difficulty in retaining users, requiring interface design to be engaging, easy
to use, create reminders and prompts [811], and allow goal setting by the user [12].
Tools should connect users with support groups that provide “social sense-making”,
with “accountability partners” [13, pg. 6938] rather than an open social media platform
which Epstein et al. [14] have shown can diffuse support and engagement. Bhargava
and Nabi [15] demonstrate that analytics must provide “thorough and continuous anal-
yses of past health status, present lifestyle, and long-term health goals of these users”
[pg. 1355]. These strategies offered useful guidance for Skiin which enables users to
curate their own support teams and offers varying temporalities of data slices. Family
informatics are a variant of social fitness, wellness, and health applications. Research
indicates that adherence, comfort and behaviours on platforms, whether health support
or safety monitoring, are mediated by family dynamics and gender roles. In Colineau
and Paris’s [16] study mothers out-performed other family members in trying to reach
and encourage collectively set goals. Technology adoption changes relationships, some-
times heightening a sense of security and shared responsibility, other times increasing,
rather than alleviating anxiety and tension [17]. Healthy “biosemiotics” feedback and
intimacy can be supplanted by tracking, [17,18] and some individuals exercise control
rather than closeness (for example over adult children). For these reasons Skiin allows
custom sharing controls for each group and individual connection in order to respect the
differences in relationships and different individual’s desire for data sharing.
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Visualizing Wellness: The Myant Skiin System Connected Life App 3
2.2 IT and Design for Older Users
Studies note the desire of seniors to be active agents who can give their best to the world
[19]. Mendoza-Núñez et al. [20] stress the importance of independence and indicate that
self-perception of well-being and health are critical to sustaining and improving health.
A goal of Skiin is to empower older adults to play an active role in self-management of
their health in order to sustain quality of life. Studies indicate that seniors’ access to the
Internet [21] and their adoption of mobile technologies, activity trackers, wellness, and
safety monitoring in and outside seniors’ homes is on the rise [2123]. Etemad-Sajadi
et al. [22] underscore the importance of perceived usefulness in seniors’ willingness
to accept a technology, linked to a sense of social presence for seniors, “that there is
personal, sociable and sensitive human contact” [pg. 1165]. Seniors trade-off privacy
concerns and utility of a technology – described as the “privacy calculus” by Schomakers
and Ziefle [24, pg. 327]. Other studies indicate that seniors will trade privacy for effective
support [6]. Users want to decide what, how, at what time, where, and to whom data is
collected and transmitted. These dynamics are even more important given the impact of
COVID-19 on seniors’ health and enforced isolation.
Studies suggest that most mobile health (mHealth) applications (apps) do not take
the needs and preferences of older adults into account. Documentation and user support
are weak. Most smartphones have not been developed with seniors in mind. To address
this challenge Morey et al. [25] provide usability design and visualization guidelines
for mobile health apps for older users and suggest an approach where seniors can add
levels of interactivity and complexity over time. A number of researchers emphasize
the need for easy access to tool tips and troubleshooting and the lack of these in many
mobile applications [26, pg. 371]. As with other demographics, seniors show a high
level of initial adoption with a degradation of use over time if device interfaces are
overly complex, or poorly designed and when the interpretive context of longitudinal
data (for instance, whether the user is in decline) is unclear [27]. Skiin will eventually
provide a chatbot with contextual information. Le et al.’s studies [6,28,29] establish that
seniors find visualizations of value in assessing their cognitive, physiological, social, and
spiritual well-being and to identify patterns where there was a change in health status.
Seniors find the analysis only to be meaningful if connected to sources of information
that help them to understand factors impacting change, to strategize interventions and
hence they ask for annotations within the data. Le et al. observed, “Older adults were
consistent in taking longer amounts of time to make assessments across both comparison
and proportion tasks compared to the general population. However, this is offset by
matching or even slightly better accuracy on the tasks” [28, pg. 55]. Visualizations are
a viable means to support information sharing for seniors.
3 Methodology
3.1 Process Overview
We applied an iterative prototyping approach to building the interface, visualizations, and
navigation strategy, developing and re-iterating components of each of the visualization
sections and linking these using a user journey map [30]. We then undertook user testing
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and are now applying results to the revised user interface and visualization strategy;
undertaking design and engineering sprints, with a future round of user testing focused
on seniors.
3.2 Visualization Interface Design Approach
We drew from an ample data visualization vocabulary [3133]. Of relevance were visu-
alization methods applied to small data sets that are interpreted within a large-scale
system that collects data from multiple individuals that it correlates and accrues over
time [34]. Our goal was to guide users through a process of insight detection [35], - pro-
viding an overview, allowing adjustment and focus, supporting pattern detection, and
then eliciting a mental model of their connections, activities, health data and locations.
Fan [36] summarizes the challenge of visualization in a context where individuals are
managing multiple types of personal information, “By changing the focus of visualizing
personal data from visualizing in an engaging and optimized way, to also visualizing
in the simplest and most relevant way, we can help users be more efficient, engaged,
and enlightened in understanding their data” (pg. 4). This challenge is amplified by the
need to manage and visualize complex data at both the granular and trend level, within
the context of a small screen. Researchers have addressed this challenge. Noirhomme-
Fraiture et al. [37] suggest the use of stacked bar charts, alternate bar charts and pixel
bar charts. Summers et al. [38] provide the concept of semantic zooming where data
visualizations are scaled up according to user navigation.
We used bar and line graphs to indicate the length and type of activity. and stacked
graphs, such as our ‘stacked, stacked’ bar graph [39] to layer background analytics of
comparative data with a graph that linked nodes. Graphs were accompanied by data tables
when appropriate. We developed and tested a series of approaches to presenting group
data, ensuring that individuals could compare their own state and status. Patient data
represented in radial displays such as the work of Zhang et al. [40], provided a helpful
example for representing complex data over time. We chose donut and circle graphs to
compare individuals within a care group [41]. Lugmayr et al. [42] provide guidelines for
simplifying health data without losing meaning. We considered and applied best practices
in representing GIS data [43] creating maps that could show and compare individual
activity pathways. These are particularly poignant when connections are undertaking
planned activities together in different parts of the world or in lockdown sites at home
or in care homes because of COVID-19.
4 Prototypes
Visualizations follow a user journey map (Fig. 1) which begins with individual log-on,
moves to a personal Metrics page and then on to Connections which brings together all
members of a support group.
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Visualizing Wellness: The Myant Skiin System Connected Life App 5
Fig. 1. Skiin user journey map
Users wear a Skiin biometric sensing garment in order to collect heart rate, loca-
tion, activity, and body temperature data. They create a health profile, identity, and pair
their Skiin Pod with the app, and then connect to their loved ones, friends, and care-
givers, with whom they can share data and vice versa see the data that their connection
decides to share with them. Through the Myant secure system individuals keep a log
of symptoms, body temperature, medication, and mood. They can link to outside sites
to access contextual data or use social networks to converse. Different views of the app
provide the user’s metrics, their diary, connections, and device management. The Met-
rics page offers their real time heart health, comparative resting heart rates, temperature,
and activities (running, sitting, sleeping and other postures) measured in time and steps,
and their location. The user can set activity and health goals and measure against these.
They can access a location view and summary of where they have been for the day,
week and month, and the types of activities there. The Connections functions of the app
and the comparative visualizations encourage social connectedness, group activities and
comparisons. A user can invite others to connect and form a group. Connections choose
the kind of data that they will share (temperature, activity, location, heart rate). The app
provides real time activity and summaries of each individual in the group’s data and
group summaries. Location data summaries show where group members are and where
their activity is occurring.
Safety features including fall detection and geofencing were added in response to
research suggesting that safety was a concern both for seniors and caregivers and should
be an option in all products for seniors [44]. A senior or individual recovering from a
health challenge can set a geofence with the expressed purpose of moving beyond this
limit if they are feeling stronger. Geofencing is not automatic and seniors and other
users can control who can set a geofence and turn sharing off and on at any time. A
communication overlay or “Aura”, indicates the continual status of each individual who
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is a Skiin user within the team. Skiin presents icons and associated actionable messages
for trouble shooting to help users understand system level issues such as low battery, or
lack of Bluetooth connection. See Figs. 2and 3, first for individuals and then for group
data.
Fig. 2. Sample visualizations: metrics data, active and resting heart rate, activity targets.
Fig. 3. Sample visualizations: aura overlay, steps one connection, activities (postures) and
connections.
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5 Usability/Usefulness Testing Process
Our goal was to obtain detailed feedback regarding the legibility and meaningfulness
of each visualization and to assess their efficacy in the dual contexts of a family and
seniors’ wellness and collaborative care tracker and a mobile application that could
effectively support senior care. We chose as diverse a sample as possible of usability
test participants within three age demographics – seniors, children of seniors and adult
grandchildren, providing a small, but rich sample of fourteen. The division into personas
roughly matched the individuals’ age. We recruited usability testers with the assistance
of Myant, our industry partner from a large staff contingent and a volunteer group that
has been recruited to test the garment interface and its application. Potential participants
filled out the Skiin Pre-test Survey which provided demographic details: age, gender,
technical capacity, perceived value in monitoring for health conditions (or not), and
experience with health, sports, and wellness monitoring. We then chose as diverse a
AQ2
sample as possible within three age demographics – seniors, children of seniors and
grandchildren, providing a small, but rich sample of fourteen. All personal data was
anonymized and analyzed in relation to the user testing results (Table 1).
Table 1. Demographic overview of usability testers
Participant # Age Gender Health
condition
Device
interaction
Use of
health and
Fitness app
Interaction
with Health
and Fitness
app
Viz
knowledge
202077P1 41–50 M Y Over 8 h Yes Frequent Advance
202077P2 51–60 F Y Over 8 h No None Basic
202077P3 Over 60 M Y 2–4 h Yes Less
frequent
Basic
202077P5 Over 60 F Y up to 1 h No Less
frequent
Advance
202077P7 Over 60 M Y Over 8 h No None Advance
202077P10 51–60 M N 4–8 h No None Advance
202077P13 Over 60 F Y 4–8 h Yes Less
frequent
Basic
202077P14 Over 60 F Y 4–8 h No Less
frequent
Advance
202077P15 26–30 M N Over 8 h Yes Frequent Basic
202077P16 35–40 M Y Over 8 h Yes Less
frequent
Advance
202077P18 21–25 F Y Over 8 h Yes Less
frequent
Basic
202077P19 26–30 M Y Over 8 h Yes Less
frequent
Basic
202077P20 35–40 M Y Over 8 h Yes Frequent Advance
202077P21 26–30 M Y Over 8 h Yes Less
frequent
Basic
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We developed an experimental approach to user testing that used three methods.
Participants were assigned goal-based, role-based personas [30,45,46] derived from
Myant’s prior market research, in order to elicit empathy and free the imagination of
the participants. According to O’Leary et al. [47], “The power of the persona approach
is due to the empathy which such well-designed characters can invoke in designers
and other stakeholders in the design process” [pg. 2917]. The three personas from the
family were a support-seeking active grandparent with a heart condition, adult child of
grandparent, and young adult grandchild. We built specific interfaces for each persona
around a unified scenario to understand the point of view and represent the behaviours
of each persona.
We used a Talk Aloud, Think Aloud method [29,48] in which the participants
explored the visualizations, first with minimal guidance from the testing team in order
to encourage “serendipitous” insights. Upon completion of a set of visualizations and
related tasks, participants were asked to verbally rate their understanding of a task
and quality of experience using a Likert scale. Video recording and transcription cap-
tured data of the task activities, and the Talk Aloud/Think Aloud commentary as testers
engaged with each set of visualizations. Understanding that seniors may take longer to
analyze visualizations [29] we did not time task performance as we were most interested
in data exploration discoveries and commentary on the efficacy of the visualizations.
We then applied the System Usability Scale [49] in an exit survey as it brings strength
in analyzing learnability and usability and is able to manage small sample sizes. Partic-
ipants undertook Talk Aloud, Think Aloud in their persona role and the SUS analysis
outside of the personas according to their demographic data.
Participants accessed a web-browser simulation of the Skiin System Connected Life
Test App through a link shared with them in an online Zoom session. They received
an orientation to the product, the app and visualizations and were given a persona to
role-play and a specific scenario that provided simulated data and visualizations for that
persona, including their own data and group data of their family connections. For exam-
ple, the Group Summary displays the primary user’s data along with all the connections
they have in a created group, hence a grandparent would see their data along with all
members of their family who are using the app and are part of their ‘family group’. The
test app had four sections, the Metrics page, Aura Overlay, Individual Summary and
Group Summary each corresponding to different data. In the scenario each lived in a
different city and all were committed to increasing their own physical activity and sup-
porting each other in doing so, while providing overall support to their grandparent. In
the scenario the family had decided to undertake a walk although at different times and
in different locations. The app indicated the activity, location, time, and related health
data. Participants explored the interfaces, visualizations, identified theirs or others’ data,
located a shared walk activity and commented on both the usability of visualizations and
the usefulness of components of the app to their persona.
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Visualizing Wellness: The Myant Skiin System Connected Life App 9
6 Overall Findings, Conclusion, and Next Steps
6.1 Usability Outcomes
In alignment with our test process, we analyzed Talk Aloud and Likert scale task surveys
by persona. We analyzed the SUS survey by overall response, gender, age, health and
fitness app experience and interaction time with digital devices on a daily basis. Skiin
met usefulness expectations as all users saw value in tracking their own data as well as
viewing and acting upon the data within their connections. The majority of testers 85.7%
(12 of 14) felt that they would use the application frequently. The two who disagreed
were frequent fitness application users under forty who interact with electronics devices
for more than eight hours a day.
Findings from the Scenarios and Likert Testing. The majority of users from each
persona were able to locate their data in the application, understand the visualizations
and relate symbols to the data types. All found that the sequence of information and
navigation strategy was logical, although several suggested entering the app through the
Connections page as social connection drives the application. The majority of partici-
pants in all personas found value in alerts regarding their or others’ heart rate and that this
data was provided in the context of activities. Users saw correlation of postures (stand-
ing, sitting, or walking activities) to wellness goals as useful. Posture (activity) summary
circles in the Individual Summary that one could compare with a connected group mem-
ber were a popular visualization. A participant lauded the tooltips which walked them
through the Aura Overlay and some suggested these tooltips be implemented for other
complex visualizations.
Under half, 42.8% (6 of 14) of participants found the icons were easy to understand,
“Data is easy to understand and interpret. Icons are helpful.” They appreciated the use
of colour coding for icons in the Aura Overlay which indicated different ranges of the
data, red for high, green for normal and blue for data not logged. A parent persona felt
that icons would prompt their parents to charge their battery. Abstract icons were not
always successful as 80% (12 of 14) across all personas found it difficult to understand
the ‘noisy signal’ symbol for the wearable garment.
Not all users saw location mapping functions as useful as a record of their activities.
Across all personas, some felt that maps could encourage group activity, yet many feared
that geolocation would intrude into their privacy. A parent persona mentioned that their
children would not be comfortable with a shared location feature if they were using the
application together as a family. A grandchild participant remarked they would not want
to reveal all of their locations to the other members of the family and especially not their
parents. These findings align with Mancini et al. [17] records of families’ discomfort
with location tracking. In contradiction, individuals in the child and grandchild personas
wished to monitor the grandparent’s location although they did not want to share their
own location data. Users in all categories wished to know what duration of presence was
required for a location to be detected and how it would be shown on the maps. They
also wanted an indication of how a senior family member (or the individual who was
the focus of care) arrived at locations (walking, transit, driving). Privacy trade-offs in
return for security [6] are evident in these comments.
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10 S. Diamond et al.
We identified usability challenges. A small minority, 14.3% (2 of 14) of the partici-
pants agreed and 7.1% (1 of 14) of the participants strongly agreed that it was difficult to
find data. 28.6% (4 of 14) of the participants disagreed that data was easy to understand.
The overall view was that the Metrics pages were legible, but that Connections pages
required simplification of data presentation and enhanced tooltips. Users of all personas
identified challenges with Summary pages, with 42.9% (6 of 14) of the participants
agreed and 7.1% (1 of 14) of the participants strongly agreed that the visualizations
were difficult to decipher on this page. Participants across all personas found the weekly
and monthly heart rate (HR) graphs difficult to decipher and understand, as the trend
lines were hard to differentiate on the mobile screen view. Some users also asked for
brighter colours, better colour differentiation and shading, echoing one of the grandpar-
ent personas who suggested, “The visuals are just too small. And there’s not enough
differentiation between the colors and I wish things were a little bit bigger. That said, it
would be fairly easy to navigate, just making things clear.”
Participants suggested providing more context for daily, weekly, and monthly heart
health and for temperature, including trend lines rather than scatter plots. Some recom-
mended simple pie-charts or bar-graphs instead of the circular visuals (used for Indi-
vidual and Group summaries) and Kagi charts (used for the activity and postures data).
Participants emphasized the value of showing an overall summary as a graph, followed
by a tabular list of data and then a detailed explanation of the data, having a macro-view
and a micro-view of data ensured there was one or the other visual that worked for each
persona. The majority of users in each persona asked for a zoom lens function and for
larger font size and image size. As one of the parent personas put it, “…zooming on the
phone if this works because it’s a touchscreen so one should be able to zoom on it so.
You could consider the size of the graphics.” Users felt that maps required enlarging
and clear positioning of legends. Skiin is intended to be a communications tool with a
seniors’ focus more than an individual wellness application, hence addressing usability
issues for the Connections and Group Summary pages will be of critical importance.
Participants suggested ways that the application could more effectively meet their
support needs, and proposed building engaging social interaction around Connections
pages, for example adding chat within a group challenge to motivate care groups to
use the app to collaborate and share wellness goals. Three users from the grandparent
persona on viewing their group connections’ location and activity visualized in the Group
Summary, exclaimed that they liked this feature where they could see everyone’s status.
This suggestion reinforces Etemad-Sajadi et al.’s [21] correlation of social presence and
usefulness. Users wanted to personalize their graphical interface, select numerical charts
versus graphs or more complex visualizations. Some wished to personalize their colours.
Individuals who assumed the child or grandchild persona expressed concern that
their parent or grandparent would find the visualizations difficult to navigate. A number
of younger users believed that the visualizations were too complex for senior users to
deal with, indicating a bias about older adults and their understanding of technology. By
contrast, a user in a grandparent persona felt confident reading the visual indications and
prompts of each icon, “I didn’t find any of them (the visualizations) difficult. I found
they were pretty obvious, you know, heart rate, temperature. I like the running shoe icon
size, the guys walking and the guy running it’s like they were all guys working out.”
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Visualizing Wellness: The Myant Skiin System Connected Life App 11
SUS Survey Results. According to the SUS the majority of users found the various
components of the application to be clear, and the data visualizations easy to use, not
requiring previous visualization knowledge, or other prior knowledge, or professional
support. Users with extensive fitness application experience felt that some functions of
the application were redundant to applications that they already used, and that data was
overly granular. A frequent user of health apps with advanced knowledge of visualiza-
tions commented, “just give me short insights and a summary, not this granular data
which I have to then interpret.” However, those that had little experience, including the
seniors testing the application, were enthusiastic about the breadth of functions. The
former would be better served by the ability to import their data from fitness apps to
Skiin.
Female respondents gave more positive responses to the majority of survey questions
than the male participants, although female users tended to express less confidence in
their use of the application than males. Sixty-five percent of users whose interaction
time with digital devices is over 8 h a day found the visualizations very cumbersome
to use. In comparison, none of the users whose interaction time is less than eight hours
with devices perceived the visualizations to be cumbersome. Our interpretation of this
finding is that the overload of digital information in frequent users’ lives could lead to
exhaustion when deciphering the visualizations.
Older respondents enjoyed the application and found the visualizations learnable. We
found grandparent personas who were also older participants by demographic analysis
were engaged and positive about Skiin and able to navigate and interpret the visualiza-
tions as well as other participants. The charts below show that the majority of users who
were over sixty strongly agreed that the visualizations were easy to use (60%), and none
of them found this application cumbersome to use (Fig. 4,5).
Fig. 4. Participant responses to the question: “I thought that the visualizations were easy to use.”
The results showed that it was not as difficult for older participants to explore the
complexity of visualizations as the younger participants presumed. Younger participants
found the visualizations were harder to use than those who were older. Despite ranking
Skiin as a valuable application that they would use, a significant minority of participants,
including the senior users who enjoyed the app felt that the visualizations were not
appropriate for seniors over 65 to use (40%). As this finding contradicts other answers,
Author Proof
12 S. Diamond et al.
Fig. 5. Participant responses to the question: “I found the visualizations very cumbersome to
use.”
we infer that this finding is driven by usability issues that were discussed in detail
in the Talk Aloud/Think Aloud process. According to the SUS survey, a majority of
participants, including seniors, reported that the graphics were not the right size for
them to see and understand (65%), and all SUS respondents requested larger graphics.
This conforms to the Likert tables. We present the macro-overview of SUS responses
below in Fig. 6.
Fig. 6. SUS responses overview
Scenario, Likert Scale and SUS Summary. It is evident that most users validated the
need for and value of Skiin, the data types collected and displayed and expressed relata-
bility to the visualization of the data for their day-to-day experiences. Critical feedback
focused on the details of the visualizations in sections where a large amount of data was
being displayed. It was evident that having different visualizations summarizing the data
with varying levels of details was helpful as eventually most users could understand the
Author Proof
Visualizing Wellness: The Myant Skiin System Connected Life App 13
data but there was a learning curve. Users who observed the Metrics section with the
individuals’ data more carefully, were able to better relate to the Connections sections
where the same data was compared with other people. Even for these users the Group
Summary section with the more complex data visualizations was challenging due to
information and cognitive load.
6.2 Conclusions
Users’ response to our designs demonstrates the usefulness of a wearable technology
visualization application that supports individual wellness and collaborative care for
families and for seniors. Skiin’s concept of a limited circle of curated connections is
supported by research [13,14]. As Rooksby et al. [7] note personal data comes from
many different sources. In order for Skiin to engage all family members it will likely need
to accept input data from users of other fitness and health informatics technologies. User
testing supported the importance of social presence and connectivity in providing value
to users. However, designs need to take privacy into account and adapt to different levels
of user permissions, in relation to location data and medical data. For example, Skiin
will need to support users who do not wish to share their location data but still wish to
participate in group care. Enabling individual fitness regimes as well as family and group
regimes, supported by diaries and information sharing may prove as valuable as group
goal setting [16] Goal setting, prompts, challenges and support, and possible rewards
may need to be integrated into the application more explicitly, replying to retention
best practices and applying principles of gamification. The Talukder et al. study [50]
indicated that seniors are more likely to accept the use of wearable health technologies
and related applications if their family, colleagues, friends, and other members of a
social circle support the use, reinforcing the value placed by our study participants in
the connection capabilities of Skiin and to design the application for the entire family
and support team. Redesign needs to strengthen an option to see data through trend lines
over longer durations for those users who want this, supporting Lee et al.’s [27] and
Pridham et al.’s [4] findings.
The use of personas and scenarios appeared to engage usability testers’ imaginations
and allowed them to move between usability commentary and discussions of the use-
fulness, improvements, and other applications for the Skiin technology. Personas and
TalkAloud feedback were balanced by the SUS evaluations which considered partici-
pants’ actual demographic positioning. The compared results provide consistencies and
differences, suggesting value in using several approaches to usability testing.
6.3 Next Steps
Skiin was originally conceived as a family informatics tool and then pulled focus onto
older adult users and their needs. Usability testing signaled means to design more effec-
tively for this demographic. Visualization simplification and increased legibility were
requested by all users. However, older adult test participants were some of the most
engaged participants in the test, interested in the widest range of the application’s capa-
bilities. Hence, we need to pursue design simplification without compromising the app’s
Author Proof
14 S. Diamond et al.
analytics capabilities. We will apply researchers’ suggestions [25,26] that seniors require
a simplified platform and the option to begin with basic tools and add levels of com-
plexity with care, older adult users vary greatly in their capabilities. In fact, all users
might want the ability to start with simple analysis, learn the app and then add more
complexity. Tool tips will be an important factor in encouraging the adoption of the full
range of capabilities.
We will refine the visualization strategy, fully applying Morey et al. [25] and Almao
and Golpayegan’s [26] principles of design for seniors, simplifying appropriate graphics
elements and introducing zoom lens capabilities. We will explore interface personaliza-
tion, strengthening the visibility of tool tips and social connectedness within the care
circle and through a chatbot. Skiin is meant to encourage goal setting by individuals
and groups and the current design sets the stage for future gamification and goal setting
within the app. Improving design for senior users will address better human computer
interaction and suite larger contexts of use for all users of Skiin.
Acknowledgements. This research is supported by the MITACS Accelerate program, Myant,
OCAD University’s Visual Analytics Lab, and the Canada Foundation for Innovation.
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2013. “The
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