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The TAC Toolkit: Supporting Design for User Acceptance of
Health Technologies from a Macro-Temporal Perspective
Camille Nadal
Trinity College Dublin
Dublin, Ireland
nadalc@tcd.ie
Shane McCully
Trinity College Dublin
Dublin, Ireland
mccullys@tcd.ie
Kevin Doherty
Technical University of Denmark
Kongens Lyngby, Denmark
kevdoh@dtu.dk
Corina Sas
Lancaster University
Lancaster, United Kingdom
c.sas@lancaster.ac.uk
Gavin Doherty
Trinity College Dublin
Dublin, Ireland
gavin.doherty@tcd.ie
ABSTRACT
User acceptance is key for the successful uptake and use of health
technologies, but also impacted by numerous factors not always
easily accessible nor operationalised by designers in practice. This
work seeks to facilitate the application of acceptance theory in
design practice through the Technology Acceptance (TAC) toolkit:
a novel theory-based design tool and method comprising 16 cards,
3 personas, 3 scenarios, a virtual think-space, and a website, which
we evaluated through workshops conducted with 21 designers of
health technologies. Findings showed that the toolkit revised and
extended designers’ knowledge of technology acceptance, fostered
their appreciation, empathy and ethical values while designing for
acceptance, and contributed towards shaping their future design
practice. We discuss implications for considering user acceptance a
dynamic, multi-stage process in design practice, and better support-
ing designers in imagining distant acceptance challenges. Finally,
we examine the generative value of the TAC toolkit and its possible
future evolution.
CCS CONCEPTS
•Human-centered computing
→
HCI design and evaluation
methods.
KEYWORDS
technology acceptance, user-centered design, design cards, technol-
ogy acceptance lifecycle, macro-temporal perspective
ACM Reference Format:
Camille Nadal, Shane McCully, Kevin Doherty, Corina Sas, and Gavin Do-
herty. 2022. The TAC Toolkit: Supporting Design for User Acceptance of
Health Technologies from a Macro-Temporal Perspective. In CHI Confer-
ence on Human Factors in Computing Systems (CHI ’22), April 29-May 5,
2022, New Orleans, LA, USA. ACM, New York, NY, USA, 18 pages. https:
//doi.org/10.1145/3491102.3502039
Permission to make digital or hard copies of part or all of this work for personal or
classroom use is granted without fee provided that copies are not made or distributed
for prot or commercial advantage and that copies bear this notice and the full citation
on the rst page. Copyrights for third-party components of this work must be honored.
For all other uses, contact the owner/author(s).
CHI ’22, April 29-May 5, 2022, New Orleans, LA, USA
©2022 Copyright held by the owner/author(s).
ACM ISBN 978-1-4503-9157-3/22/04.
https://doi.org/10.1145/3491102.3502039
1 INTRODUCTION
Users’ acceptance of health and mental health technologies is key to
their successful design, uptake and use. As new technologies, from
smartwatches to virtual reality headsets, are increasingly employed
for diagnosis, treatment, and monitoring [
72
], evidence of clinical
eectiveness is critical to their success in practice, yet not alone
sucient for individuals’ willingness to take on and engage with
the technology. User acceptance — an individual’s perception of a
technology leading to its use or non-use — is impacted by numer-
ous factors, which have been articulated by multiple models over
the past three decades [
21
,
95
,
96
,
98
–
100
]. Despite such models
however, it has been argued that our understanding of user accep-
tance in research practice is limited by the existence of precisely
such numerous and diverse interpretations of the concept, at times
incongruent with theory, as well as the inconsistent use of theory
to support exploration and measurement [
63
]. Our perception of
any one technology evolves over time: we may, for example, take
up a new device, and only a week later discontinue its use. In the
design of healthcare technologies, it is critical to understand and
address the reasons for such abandonment, in particular given the
longitudinal nature of care and trajectories of many chronic condi-
tions. Despite the concept’s importance, user acceptance is often
overlooked during the process of design [
63
]; existing methods
for attending to acceptance requiring the review of a large set of
acceptance factors [
22
], or focusing arbitrarily on a few [
29
,
91
,
104
].
This paper strives to address this gap between theory and prac-
tice, by introducing the Technology Acceptance (TAC) toolkit —
a novel design tool to support designers’ reection around user
acceptance and its evolution across the user journey. We report
on the evaluation of this toolkit by means of 7 workshops, con-
ducted with 21 designers of health and mental health technologies
with interdisciplinary expertise. These workshops were designed
to support analysis and understanding of the following research
question: What is the value of the TAC toolkit for supporting reec-
tion on technology acceptance and designing for acceptance from a
macro-temporal perspective?
Our contributions are three-fold, including (i) the TAC toolkit as
a novel design tool and method to help designers leverage accep-
tance theory and apply it to the design of health technologies, (ii)
the macro-temporal perspective as a means to support design for
acceptance featuring temporal multi-choice scenarios, and (iii) im-
plications for considering user acceptance a dynamic, multi-stage
CHI ’22, April 29-May 5, 2022, New Orleans, LA, USA Nadal, et al.
process in design practice, better supporting designers in imagining
distant user acceptance challenges, and examining the generative
value of the TAC toolkit and its possible evolution over time.
2 RELATED WORK
Design for user acceptance of health technologies requires rst
understanding existing theories and the temporal dimension of the
process, and secondly leveraging this knowledge in design practice.
2.1 Modeling User Acceptance
Research has extensively explored the reasons behind users’ ac-
ceptance or rejection of technology [
71
]. Technology acceptance
research initially focused on the workplace context, leading to mod-
els including the Technology Acceptance Model (TAM) [
20
], its
extensions [95, 96, 98], and the Unied Theory of Acceptance and
Use of Technology [
99
], before exploring broader contexts [
15
,
100
].
As digital innovation gained traction in the healthcare context,
user acceptance theories evolved accordingly, producing many new
models [
12
,
23
,
27
,
41
,
46
,
79
]. The expansion of acceptance theories
to the health domain, while welcome, has therefore also resulted in
a wide range of additional models, presenting diverse and numer-
ous inuencing factors. This complexity has rendered the eld of
knowledge dicult to navigate for designers of health and wellbe-
ing technologies. Although Marangunić et al. reported “continuous
progress in revealing new factors with signicant inuence on
the core variables of the [TAM] model” [
50
, p. 81], Nadal et al.’s
review [
63
] showed that interpretation of user acceptance varied
signicantly among digital health researchers, perceived usefulness
being the factor most investigated, and that few studies engaged
with acceptance models. Additionally, a strand of the literature has
argued for considering user acceptance as a multi-stage process,
evolving over time [
24
,
32
,
52
,
63
,
70
,
80
,
85
,
89
]. Recently, the Tech-
nology Acceptance Lifecycle (TAL) [
63
], for example, articulated
the stages of user acceptance according to the continuum pre-use
acceptability—initial use acceptance—sustained use acceptance.
The rich body of work on technology acceptance has thus to date
proved predominantly theoretical, focusing on models and factors,
with limited accounting for the temporal aspect of acceptance.
2.2 Designing for User Acceptance
Despite the rich theoretical framework of acceptance, attempts to
attend to this concept at design stage often consider only a small
subset of acceptance factors present in validated models. Among
these, perceived usefulness and perceived ease of use are the most
addressed in design practice [
29
,
91
,
104
], although researchers
have stressed the diculty of addressing these factors in design
[
91
], and the need for novel standardized design approaches [
104
].
Other design approaches include Detjen et al.’s method — employed
in relation to acceptance of automated vehicles — of rst reviewing
existing acceptance models and comparing their dierent sets of
factors, then reviewing existing approaches for addressing these
factors, and nally formulating guidelines to design for user accep-
tance of these particular technologies [22].
While we therefore recognize researchers’ eorts to rely on val-
idated acceptance theories, current practices seem to focus on a
subset of acceptance factors. This means that other potentially
relevant factors (such as self-image,technology anxiety, etc.) are
overlooked, reducing opportunities to improve the resulting de-
signs. The lack of standardized approaches to design for acceptance
furthermore leaves designers uncertain as to how to address accep-
tance in practice. This might result in a greater focus on acceptance
at the deployment stage, instead of throughout the entire design
process when challenges may more feasibly be addressed [
54
,
98
].
Finally, while studies have occasionally attempted to account for a
wider range of acceptance factors in design, doing so has required
extensive reviews of the literature — an approach unsustainable for
many design projects.
2.3 Temporality in HCI
The evolving nature of user acceptance furthermore suggests the
need to consider how temporality is addressed in HCI research.
Temporality has recently received attention beyond the traditional
clock-time perspective, encompassing also socio-cultural and ex-
istential aspects of time [
69
]. These latter aspects have primarily
been explored through the lens of user experience (UX), frameworks
emphasizing the episodic quality of discrete experiences [
31
], or
highlighting its felt-life quality [
26
,
55
]. This early work has focused
on discrete events, failing to capture the temporal richness and com-
plexity of users’ patterns of interaction with technology [26].
Other related work has focused on the adoption of domestication
theory [
83
], describing the three stages of technology adoption:
commodication raising expectations of technology’s function and
value before its use, appropriation during which users integrate
technology into their lives, and conversion whereupon users accept
the technology as reecting their self-identity and signaling status.
Karapanos et al.’s framework of user experience over time [
44
],
additionally argues for the importance of moving from the micro-
temporal perspective of how user experiences are formed, modied
and stored, to how they change over time [
44
]; positing 4 key UX
phases: anticipation,orientation,incorporation, and identication.
Temporal richness can also be surfaced by examining interac-
tions over time intervals, rather than at discrete time points [
30
,
42
].
Yet, limited work has explored the trajectory approach to user ex-
perience, with a small number of exceptions including Benford and
Giannachi’s framework for capturing the chronology of events in
mobile games [
6
]. The concept of interactional trajectory also ex-
tends the traditional user journey “through a user experience” [
93
]
to richer trajectories “over space and time [involving] multiple
roles and interfaces” [
7
]. Most recently, temporality in HCI has
been considered in speculative and futuring design [47].
The growing body of HCI research on temporality has thus
mostly focused on interaction at the micro level or adopted the lens
of situated and discrete user experiences — with much less work
exploring the macro level perspective as to how user experiences
change over time.
2.4 Design Tools to Bridge Theory & Practice
and Represent User Trajectories
HCI researchers and designers have previously devised a variety of
methods for bridging theory and practice [
17
,
94
] during the early
stages of technology design [
76
], including cards [
35
], personas,
scenarios, cultural probes [
33
,
34
], and toolkits [
45
,
48
,
66
,
75
,
90
].
The TAC Toolkit: Supporting Design for User Acceptance of Health Technologies CHI ’22, April 29-May 5, 2022, New Orleans, LA, USA
Design cards in particular are often employed in early design, to
support practices of reection, ideation, and communication [
8
,
66
].
The potential of these methods to succinctly communicate the-
oretically abstract concepts has led to the development of cards
articulating concepts and models as diverse as the Tangible Interac-
tion framework [
40
], Exertion framework [
60
], Playful Experiences
framework [
49
], and child developmental concepts [
5
]. Designers
of these card decks have drawn on a variety of means of commu-
nication, from sensitizing questions and illustrative images [
40
],
to thematic thought-provoking questions [
60
], quotes, and both
textual and graphical descriptions of activities [5].
The use of design cards in practice can also be supported by
the parallel adoption of other design tools, including personas and
scenarios, as means of depicting and anchoring users’ interactions
in relation to hypothetical future systems [
16
,
25
]. Usually depicted
in text form, scenarios can also be augmented visually [
25
], or ren-
dered interactive, as in the case of hands-only [
11
], role-play [
102
],
and design Thing’ing scenarios [
82
]. More recently, scenarios have
also been used as means to educate designers in relation to theory
(e.g. social science theories [
102
], psychology theories [
68
]), or to
sensitize designers to users’ feelings and lived experiences [
74
].
Personas and scenarios have nally been widely employed for the
design of health technologies [36, 92, 101, 103].
Design cards’ long history of the eective communication of
theory suggests their potential as means of operationalizing the
rich theoretical space of user acceptance, if made, and considered
accessible, engaging and meaningful to practising designers. Em-
ployed alongside personas and scenarios, cards may furthermore
prove means of usefully representing the temporal unfolding of the
user acceptance journey with digital health interventions.
3 INTRODUCING THE TAC TOOLKIT
To address the challenge of designing for health technology ac-
ceptance — surfacing what matters most to designers and users
in regard to health technology acceptance, and in turn supporting
improved alignment of their needs and values — we developed the
Technology Acceptance (TAC) toolkit. The toolkit aims to (i) render
user acceptance theory more accessible to designers, (ii) produce a
true-to-life context in which to weigh questions pertaining to user
acceptance of technology, and 3) create a space in which to reect
upon and begin designing for health technologies. While diverse
stakeholders might be involved in the use of health and wellbeing
technologies, the TAC toolkit has as its primary target audience
designers developing health and wellbeing technologies for users
receiving support directly through these technologies. Materials in
support of these aims were developed by the authors through an
8-month iterative design process.
Sensitively designed and informed by existing models of user
acceptance, the TAC materials in their nal form consist of ve
primary components: a set of 16 cards, 3 personas, 3 scenarios, a
virtual think-space, and a website.
3.1 Designing the TAC Cards
Designing the cards involved the careful selection of relevant tech-
nology acceptance models, identication of key antecedent factors,
and the design of the cards’ textual and visual content.
3.1.1 Selecting the Models of Technology Acceptance. Drawing on
the acceptance literature, we selected validated models as the theo-
retical basis for the TAC toolkit. We rst considered those models
and extensions constituting the current theoretical foundations
of technology acceptance: the TAM [
20
], TAM2 [
98
], TAM2’ [
95
],
TAM3 [
96
], and UTAUT [
99
]. Next, we included models pertaining
to pervasive technologies: the UTAUT2 [
100
], and PTAM [
15
]. Fi-
nally, we incorporated acceptance models devised specically for
the healthcare context: the HITAM [
46
], Hsu et al.’s model [
41
],
Dou et al.’s model [
27
], Cheung et al.’s model [
12
], Schomakers et
al.’s model [79], and Dhagarra et al.’s model [23].
3.1.2 Identifying the Key Concepts across the Selected Models. In
order to ground discussion among designers in pragmatic terms
pertinent to real-world design choices, we chose to focus the TAC
cards on antecedent factors, representing explanatory variables
impacting user acceptance. Table 1 provides a complete overview
of the 16 antecedent factors included within the nal TAC card
deck, along with their denitions, and models of origin. To maintain
a clear focus on the health context, we additionally excluded those
constructs highly particular to the use of technology for work (e.g.
job relevance [
98
,
99
]). Where models overlapped, similar constructs
were regrouped as a single unique factor to facilitate their inclusion
(e.g. reference group inuence [
12
] and voluntariness to use [
96
,
98
,
99] were regrouped under social pressure).
3.1.3 Developing the Cards’ Textual and Visual Content. Each card
in the TAC deck
1
represents a single antecedent factor of technol-
ogy acceptance, depicted on the front side in the form of a title and
icon combination, intended to support memorability and the ability
to easily distinguish cards from one another (see Fig. 1). Following
both the common acceptance literature practice of categorizing ac-
ceptance factors [
27
,
46
], and Alkhuzai and Denisova’s design card
heuristics recommending the grouping of cards and dierentiation
of groups using color [2], we created three color-coded categories
pertaining to Health (red), Individuality & Social context (orange),
and Technology (blue), linking each of the 16 TAC factors to the
category most closely related to their denition. This categorization
was devised to both facilitate users’ familiarization with the cards
and increase the learnability of the 16 acceptance factors.
Inspired by previous work concerning the value of sensitizing
concepts [
76
] and interaction design tools intended to make frame-
works (including for tangible interaction [
81
]) more accessible, we
furthermore developed a series of thought-provoking, sensitizing
questions pertaining to each factor (displayed on the back of each
card). The rst of these questions served to communicate the fac-
tor’s denition in an accessible and engaging fashion, while the
remaining questions encouraged deeper reection in relation to
dierent and specic aspects of the concept’s denition. The cards
were nally designed to resemble playing cards in support of user
engagement.
1
The complete set of TAC cards is available for download from the supplementary
materials.
CHI ’22, April 29-May 5, 2022, New Orleans, LA, USA Nadal, et al.
Table 1: The acceptance antecedents covered by the TAC cards, by category, alongside their denition and models of origin.
Factors Denitions Models
Health
Health status Whether one “has any diseases or comorbidity” [46, p. 3]. [46]
Health beliefs and
concerns
Perceived susceptibility and issue severity [37]. [12, 46]
Healthcare professional
relationship
Trust in clinician to deliver accurate health information, and help seeking
behavior [27].
[27]
Individuality & Social context
Demographics Gender, age, socio-economic status [15, 99, 100]. [15, 99, 100]
Resistance to change “People’s attempt to maintain their previous behaviors and habits in the face of
change required” [27, p. 3].
[27]
Self-image “The degree to which use of an innovation is perceived to enhance one’s image or
status in one’s social system” [59, p. 195].
[96, 98]
Social pressure
“The perceived social pressure to perform or not to perform the behavior” [
1
, p. 454].
[
12
,
15
,
46
,
99
,
100]
Perceived social
support
Facilitating conditions, or “the availability of resources needed to engage in a
behavior” [88, p. 139].
[12, 95, 96]
Technology
Technology anxiety
“The fear or apprehension felt by individuals.. . when they considered the possibility
of computer utilization” [84, p. 238].
[46, 95, 96]
Perceived reliability Output quality (“how well the system performs [required] tasks” [98, p. 191]) and
result demonstrability (“tangibility of the results of using the innovation” [
59
, p. 203]).
[46, 96, 98]
Technology playfulness
“The degree of cognitive spontaneity in microcomputer interactions” [105, p. 204]. [46, 95, 96]
Technology enjoyment “The extent to which the activity of using a specic system is perceived to be
enjoyable in its own right” [95, p. 351].
[46, 95, 96]
Privacy protection “Concern for loss of privacy and need for protection against uncalled-for
communication and misuse of personal information” [23, p. 4].
[23, 41, 79]
Trust Belief that “the healthcare provider [will] fulll [the patient’s] needs” [23, p. 4]. [23]
Objective usability Construct allowing to “compare dierent systems using objective measures of
usability/system characteristics” [97, p. 457].
[27, 46, 95, 96]
Integration “How well the technology is integrated into our lives” [15, p. 4]. [15]
3.2 Crafting the TAC Context
Primarily envisioned as an exploratory design method for use early
in the design process, the TAC toolkit furthermore comprised per-
sonas, scenarios, a think-space, and a website.
3.2.1 The TAC Personas. We adopted the use of personas and sce-
narios as means of crafting a realistic context for reection on
technology acceptance on behalf of persons receiving health or
mental health care, both as a means of providing examples of an
implementation of the acceptance journey, and for enabling us to
explore one possible use of the TAC cards in the design process.
Through iterative collaborative design, we developed 3 personas2,
each associated with a respective scenario. While designing these
personas, we aimed to ensure diversity of age, gender, and health
concerns, creating three ctional characters living with common
yet diverse health issues, for which technological solutions are of-
ten oered. These include Ella, a young woman and trainee solicitor
diagnosed with type 2 Diabetes; Ali, an elderly bereaved spouse and
retired orist, prescribed and struggling to manage antidepressant
medications; and Alex, a middle-aged bus driver and father of three,
2The 3 TAC personas are available at [62].
worried about the possibility of catching COVID-19 and passing it
on to his family. Each persona was dened in terms of information
including demographic details (i.e. age, occupation, health status,
social context), experience with technology, challenges faced, and
personal traits that may inuence acceptance of technology.
3.2.2 The TAC Scenarios. In parallel with these personas, we de-
veloped 3 scenarios
3
designed to inspire engagement with the un-
folding of each persona’s interaction trajectory with a pertinent
technology, namely a glucose monitoring sensor and app (Ella, Dia-
betes), medication reminder app (Ali, depression), or governmental
contact tracing app (Alex, COVID-19). To account for the evolving
nature of user acceptance over time, we emphasized the macro-
temporal perspective of technology acceptance by employing the
Technology Acceptance Lifecycle (TAL) timeline to structure each
scenario in terms of the 3 consecutive stages of pre-use acceptabil-
ity,initial use acceptance, and sustained use acceptance [
63
]. The
pre-use acceptability stage encompasses the period before any in-
teraction with a technology occurs, but when both awareness and
contemplation of its use surface. Thus, drawing also from previous
3The 3 TAC scenarios are available at [62].
The TAC Toolkit: Supporting Design for User Acceptance of Health Technologies CHI ’22, April 29-May 5, 2022, New Orleans, LA, USA
Figure 1: Examples of TAC cards showing on the front antecedents of technology acceptance: (a)Social pressure, (b) Health
beliefs and concerns, and (c) Trust, and on the back sensitizing questions.
work, 2 specic and critical temporal milestones in this stage were
identied as seeking advice (a critical step in an individual’s health
trajectory [
67
]), and choosing technology (the decision to start using
a health technology [
86
]). The very rst interaction with a technol-
ogy marks the end of pre-use, and the beginning of the initial use
acceptance stage. Here, to facilitate exploration of a more granular
time scale, we considered the following 3 temporal milestones: rst
interaction,next day, and a week later. Finally, in the last stage of
sustained use acceptance, we considered the following temporal
milestones: after 1 month,after 3 months, and after 1 year — the
rst 2 of which have been suggested as milestones for long-term
acceptance in previous work [
98
], while the last was added to reect
the lengthy or lifelong nature of many health conditions.
To support rich engagement on behalf of designers, we further-
more identied and described for each specic milestone 3 paths;
each recounting acceptance issues of either high, medium or low
degrees of challenge. For this, we drew inspiration from interactive
narratives [
3
], where multi-choice scenarios have been employed in
place of linear sequence stories or traditional linear scenarios. Thus,
at each temporal milestone, designers can choose among 3 dierent
paths that which they would prefer to explore (see Appendix A).
Design tools fostering empathy have long acknowledged the
value of scenarios, in the mental health context in particular, from
video stories [
38
] to vignettes, as means of describing the lived ex-
perience of ill health [
74
], or supporting therapeutic role-play [
53
].
To further elicit empathy in this case, both personas and scenarios
were written in the rst person, and employing believable, col-
loquial language. We aimed to furthermore increase empathetic
engagement through the use of role-play, as previously employed
to support the design of health technologies [53].
CHI ’22, April 29-May 5, 2022, New Orleans, LA, USA Nadal, et al.
Figure 2: Scenarios’ temporal milestones, alongside the 3 stages of the Technology Acceptance Lifecycle [
63
]: pre-use acceptability,
initial use acceptance, and sustained use acceptance.
3.3 Devising the TAC Process
The nal step in completing the design of the TAC toolkit was to
provide designers a space in which to collaborate and interact with
the TAC cards, personas, and scenarios.
3.3.1 The TAC Think-Space. To enable designers to work collabo-
ratively with the TAC cards in relation to specic design problems,
we created a virtual board using the online platform Miro [
58
]. This
think-space enabled participants to interact with the TAC cards
in virtual-analogue form, displaying their front side only, in a col-
laborative digital space, at the same time as interacting with the
physical deck. This space allowed designers to place selected cards
against each temporal milestone of the user journey, while making
notes reecting their decision-making process to the side (Fig. 3).
3.3.2 The TAC Website. Finally, as multi-choice scenarios can be
more eectively implemented digitally, we also developed the TAC
interactive website [
62
] to host the digital personas and scenarios
(see Fig. 4).
4 EVALUATING THE TAC TOOLKIT
We designed a study to support evaluation of the TAC toolkit as
a novel exploratory design tool with the aim of gathering insight
into designers’ experiences of using the toolkit, and perceptions of
its value for designing for user acceptance of health technologies.
4.1 Participants
We recruited designers of health and mental health technologies
through our personal and professional networks as well as Twitter
postings. Participants were deemed eligible if over 18, procient in
Figure 3: Post-workshop think-space (Group 5) showing the 3 stages of technology acceptance (top), the cards selected by
participants for the 8 temporal milestones (middle), and the 16 TAC cards color-coded by category (bottom).
The TAC Toolkit: Supporting Design for User Acceptance of Health Technologies CHI ’22, April 29-May 5, 2022, New Orleans, LA, USA
Figure 4: Website view of persona Alex’s (COVID-19) scenario.
The current milestone is ‘First interaction’, with 3 possible
paths forward in the event of rst launching a contact tracing
app: “Is this thing working?” (high degree of challenge), “I’ve
heard it’s a big drain” (medium degree of challenge) and
“Well, that was easy” (low degree of challenge).
English, and currently actively designing digital health or wellbeing
interventions. The study was approved by the SCSS Research Ethics
Committee at Trinity College Dublin, and designers received a £20
Amazon voucher for their participation in the workshop (
≈
1h30)
and follow-up interview (
≈
30min). Participants’ ages ranged from
25 to 34 (17), and 35 to 44 (4). Ten identied as female, 10 as male
and 1 preferred not to disclose their gender. Most originated from
within the EU (15), and all were working in Europe: 14 in academia
(4 with prior industry experience) and 7 in industry; 16 in the design
of mental health technologies, 5 in health, and 3 in both. This partici-
pant sample spanned multiple degrees of expertise: 11 PhD students,
3 post-doctoral researchers, 3 senior researchers (1 lecturer, 1 assis-
tant professor, 1 digital health scientist), 1 clinical trials associate, 1
digital health project manager, and 2 UX designers. We also sought
to recruit individuals with diverse backgrounds to reect the in-
terdisciplinary work of designing health technologies, resulting
in a diverse range of participants specializing in HCI (8), clinical
psychology (4), design (4), HCI and psychology (2), biomedical en-
gineering (2) and software engineering (1). Two participants (P16
& P20) had previously encountered particular acceptance theories
in their work; the remaining 19 participants disclosed no previous
experience with acceptance-related theoretical frameworks.
4.2 Method
The 21 participants were divided into groups of 3 prior to the work-
shops: each group including at least one person with a background
other than HCI, in order to simulate the diversity of expertise typi-
cally encountered in design teams. The 7 workshops took place in
the form of Zoom sessions, supported by a single facilitator (either
authors 1, 2 or 3). At the start of each session, each participant read
the study information sheet, provided digital consent, and answered
an online demographic survey. The facilitator then described the
purpose of the workshop (i.e. an opportunity for researchers to
understand, and participants to gain insight into technology accep-
tance and new design tools), and conrmed that all participants
had access to both the physical and digital materials. The facili-
tator then explained that one person in the group would play a
ctional user experiencing health or mental health diculties, in
the form of a persona to-be-selected, while both others would play
the the role of designers. Each group decided among themselves
who would take on that role — a choice made to strengthen users’
ownership of the scenario and overall process. Once roles were
claimed, the workshop then proceeded following the 9 steps de-
scribed in Figure 5; the 2 designers and single user attempting to
expose technology acceptance issues while traversing and actively
shaping the persona’s narrative throughout the user journey, and
discussing possible design actions in response to issues as they
arose. Following the workshop, each participant took part in a 30-
minute semi-structured interview, during which they were asked
about their experience and perceptions of the dierent elements of
the toolkit and method employed4.
4.3 Data Analysis
Each workshop and interview was audio recorded, totaling over
20h of audio, including 9h42m (an average of 1h23m per group)
from the workshops, and 10h50m (an average of 30min per par-
ticipant) from the interviews. These recordings were anonymized
and fully transcribed. Firstly, an inductive thematic analysis of
workshops and interview transcripts was conducted by authors
1 & 2, following Braun and Clarke’s approach [
10
]. This process
entailed successive readings of the transcripts and familiarization
with the data, complete coding of the data, pattern identication
and analysis, denition of themes, and reporting of ndings. Then,
a deductive thematic analysis of the same data set was conducted
by the rst author, focusing specically on the temporal dimension
of participants’ experiences with the TAC toolkit, and grounded in
the TAL timeline [
63
]. Finally, each group’s completed think-space
board was captured, and examples extracted to illustrate and further
support results of the thematic analyses.
5 FINDINGS | INDUCTIVE THEMATIC
ANALYSIS
Inductive thematic analysis of these 7 workshops and 21 interviews
provided insight into participants’ actual and possible future use
of the TAC toolkit, including in particular its value for bridging
theory and design practice, and for fostering richer conversations
and reection on users’ acceptance of health technologies.
5.1 Bridging Acceptance Theory and Design
Practice
One of our primary aims in designing the TAC toolkit was to help
bridge theory and practice for the design of health technologies
that account for users’ acceptance. Findings from both workshops
and interviews highlighted the threefold value of the TAC toolkit
in facilitating such bridging through challenging designers’ pre-
conceptions about technology acceptance and extending their un-
derstanding, motivating the application of technology acceptance
theory through role-play, and shaping designers’ actions to better
account for user acceptance.
4The Interview Guide is available in supplementary materials.
CHI ’22, April 29-May 5, 2022, New Orleans, LA, USA Nadal, et al.
Figure 5: Workshop procedure showing the 4 activities performed by the designer role-playing the persona (top) and the 5
performed by the two other designers (bottom).
5.1.1 Challenging Designers’ Preconceptions about User Acceptance.
It was through challenging participants’ preconceptions of accep-
tance that the impact of the TAC toolkit was rendered most visible.
In particular, designers commented often on the role of the toolkit
in challenging a commonly-held assumption that the question of
acceptance ceases to prove relevant once the user begins using the
technology: “You made me realize that you have to consider accept-
ability at dierent points and that this acceptability may change be-
cause the needs of the user may change over time” (P14). Participants
spoke then of coming to conceive of acceptance as a dynamic pro-
cess, in line with the underlying theory [
24
,
32
,
52
,
63
,
70
,
80
,
85
,
89
].
A participant with some prior familiarity with existing models of
acceptance, explained: “It denitely makes you think about the tech-
nology [as] less static.. . something that needs to kind of grow and
continue with this person and their needs” (P20). This comment
suggests renewed awareness of the value of exploring acceptance
across the entire user journey. This can in turn foster greater sensi-
tivity towards the design of complex technologies, as required to
accommodate users’ evolving needs.
Responses additionally indicate that the toolkit’s timeline and
cards’ three categories provided designers a means of visualizing
this transformation of users’ needs. For example, on reviewing
their nal think-space board, P17 noted that “it is quite interesting
how the ‘social context’ is at the beginning, and then the ‘health’
cards are at the beginning and end.. . and the ‘technology’ cards
are all over [the user journey]”. This reects an understanding of
acceptance as extending beyond the pre-use stage and indicates
an emerging practice among designers of linking the process
of acceptance to the user journey: “It really helps to re-focus
the design in a user-centered perspective all along, and going from
the short [term]. . . to the use and adoption of the device in [the]
long-term” (P9). This key nding suggests heightened awareness
of evolving use and user acceptance over time, as further reected
in P14’s comment concerning the importance of accounting for
the possible evolution of user needs: “when people are using
it [the system], maybe we forget that we still need to make some
adjustments”.
Some designers also reported that acceptance issues began to
feel even more concrete in the later stages of the user journey,
where issues become “tangibles, whereas in the beginning there’s still
a lot of too many [sic] intangibles” (P18). This was an impression
described as further accentuated by the role-play component of the
scenario: “It becomes more personal because I’ve now invested a year
in this thing [technology]” (P5, playing the persona). These moments
of insight pertained not only to the concept of user acceptance
in a broad sense but also to the nature of health technologies in
particular. This was highlighted by P1, a designer with a mixed
HCI and psychology background, who pointed out that designing
healthcare technologies was a complex process “with lots of dierent
stages, and dierent stakeholders” and that therefore, the path to
acceptance was likely to be longer than for other technologies.
Finally, engaging with the TAC cards during these sessions ap-
peared often to nurture designers’ appreciation for, and chal-
lenge their understanding of acceptance factors in particular,
leading them to develop a richer understanding of their denition
and interaction, through reection on the cards and conversation
with other participants. P11, for example, speaking of the factor of
‘trust’, explained coming to understand that “it is not only about
‘trust’ as in ‘the data is safe’, but there’s also other aspects that we
should consider”.
5.1.2 Extending Designers’ Understanding of Technology Accep-
tance. The TAC toolkit also expanded designers’ perspectives on
user acceptance, exposing factors that some wouldn’t have other-
wise considered: “I hadn’t thought about all those forms of acceptance
The TAC Toolkit: Supporting Design for User Acceptance of Health Technologies CHI ’22, April 29-May 5, 2022, New Orleans, LA, USA
before, I think particularly the social ones” (P5). The number of fac-
tors inuencing acceptance was also spoken of as a surprise by
many designers: “I would never have thought of that many factors
at play” (P6) and “I was not familiar with all these factors. . . My
spectrum and my way of speaking changed around that topic” (P21).
Selecting positive user stories during the multi-choice scenar-
ios made some designers realize that, even when ‘all is going well’,
there may still be room for improvement in terms of user accep-
tance. As P14 commented, even if “everything went well, still there
was a bone that you could try to address” — a point also reected
in Group 2’s notes made using the think-space “The user seemed
to be enjoying/accepting the app enough to be prompting friends to
install it. [Design action:] Include easy sharing mechanic to allow viral
spread”. One participant furthermore reected as to how “designers
are trained to look at barriers” while there is also value to be found
in amplifying positive elements: “I like the idea of choosing some
of the positive stories.. . we can think about how could this ‘social
support’ or ‘enjoyment’ of the technology be amplied?” (P1).
The multi-choice scenarios also helped designers picture the
range of possible user experiences. P17, for instance, who was
playing the persona and therefore had to pick a path at each scenario
step, described how “it’s quite interesting to see the dierent sorts of
people that you may nd”. Although real-world acceptance issues
often involve a mix of factors, we initially asked participants
to pick only one card per scenario step, to encourage negotiation
and deeper conversation within groups, through trade-o-driven
design [
60
]. While discussing cards for the rst step however, all
groups asked if they could select several cards, as they felt one
wasn’t sucient to cover the factors at play. The facilitator then
informed participants that they could pick multiple cards if they felt
several factors were involved. We provided designers this auton-
omy during sessions in order to avoid creating an overly articial
study context. P20 commented: “if we’d only picked one, then maybe
some important things wouldn’t have been considered. . . we’d never
have ‘privacy protection’ in there”. Group discussions furthermore
revealed close relationships among factors, and their negotiation.
Group 2, for example, discussed the interplay between ‘social sup-
port’ and ‘social pressure’ — “This support through pressure.. . It’s
like the strategy to provide the ‘social support’ is ‘pressure’. It’s why
it feels so entwined” (P5). Participants also spoke of and leveraged
the positive vs. negative impact of acceptance factors — “before
it was a lack of ‘trust’ and now it’s too much” (P13) — and suggested
making this positive/negative outlook more visually explicit in us-
ing the TAC cards by, for example, ipping the card upside down
on the board (Groups 1 & 2).
Participants additionally came to recognize developing an accu-
rate understanding of users’ needs as a less than straightforward
process. They did comment however that the TAC cards helped
identify users’ needs: “I feel like users are very complex and it [the
cards] were helping me maybe see the nuances” (P17), by “facilitating
a faster understanding of what are the main targets, the main things
to design for” (P11). One developer commented that “it’s hard to
design for a person as opposed to for a person’s needs” (P4), elabo-
rating that the cards allowed them to “turn this user into a set of
experiences and actions” in order to nd “the set of steps to solve this
[acceptance] problem”.
5.1.3 Motivating the Application of Acceptance Theory through
Playfulness. During interviews, the physicality of the cards was
continually raised as a positive aspect of participants’ experience.
In particular, most participants enjoyed the playfulness of the TAC
toolkit and compared it to a game: “It felt like playing a board
game, because the physical cards, the notion of placing things, the
notion of choosing. . . gave a tactile nature to it that I really liked”
(P4). We observed that this playfulness encouraged designers
to translate acceptance theory into practice. P4 explains how
the physicality of the materials made it feel as if they were ‘solving
a mystery’: “Holding the cards, but in a way that the cards are telling
a story. . . The mystery is how do we improve the user’s journey with
an app?”. The challenge of determining the inuencing factors at
each of a scenario’s temporal milestones made the task meaningful
and engaging: “It felt almost like we were trying to nd the right
answer. Even though there is no right answer, that’s not the point”
(P3), and additionally highlighted designers’ understanding that
there is no exact truth — in that the factors selected depended
upon designers’ interpretation of the scenario. Finally, participants
felt satisfaction at being able to leverage the complex issue of
acceptance, “touch[ing] on kind of the core components of a really
complex problem and tech solution” (P7).
5.1.4 Supporting the Negotiation of Acceptance Factors. The phys-
ical externalisation of the selection process was furthermore de-
scribed as helping participants determine which acceptance
factors were, or were not, relevant to a given scenario: “I like
physical stu to touch, move around.. . To say ‘this card does not ap-
ply’, I’m literally physically gonna put it over here behind my monitor
and not look at it” (P3). Participants typically began this decision-
making process by considering all of the cards, usually face up,
before making an initial selection of 3 to 6 cards deemed relevant
for the factor at hand. They would then turn the selected cards
over, read the sensitizing questions on the back, and discard the
less relevant factors. This practice aligns with descriptions found
within the broader literature of a simplied comparison process
entailing twin stages of orientation or familiarization with the cards
[
5
,
40
,
60
], and (re)framing of the problem space by selecting and dis-
carding cards [
5
]. Some participants described arranging the cards
spatially on their desk to prioritize the factors they judged most
relevant to the scenario step in question: “I had them [the cards]
on the keyboard.. . I could put them forward and backwards. .. to
physically prioritize them” (P4).
Finally, the tangibility of the cards was commonly reported as
both helpful and refreshing in the context of the hybrid setting. In
particular, working with the physical cards appeared to en-
courage individual reection, allowing participants to examine
the factors and form their opinion at their own pace, while also
selecting those they felt relevant without being overly inuenced by
the other designer’s choices: “It frees your thinking when you have
something tangible, and you’re not just staring at a screen and other
people, what they’re picking out. I had my cards here in my hand. I felt
quite free to pick as I wanted” (P6). Instances of physical interaction,
from displaying cards to the camera to shuing cards in hand, were
often observed during the workshops — the combination of physi-
cal and digital appearing to render the experience more tangible
and meaningful. The sensitizing questions on the back of the cards
CHI ’22, April 29-May 5, 2022, New Orleans, LA, USA Nadal, et al.
helped designers (in)validate their intuition about the accep-
tance factors at play, as reected in a comment made during Group
5’s workshop: “I denitely think there’s elements in the ‘self-image’
that is related to this situation, as in ‘Might the technology itself carry
a medicalizing or even stigmatizing eect?’ [sensitizing question]”
(P15). Finally, the 3 categories of cards furthermore shaped design-
ers’ reections in relation to acceptance at dierent points of the
user journey. For instance, P17 (who played the persona) explained
to their group: “In this stage, my main worries are about the ‘social
context and individuality’ because I don’t think I’m thinking about
[the] technology per se”.
5.1.5 Shaping Designers’ Practice to beer Account for Acceptance.
During the interviews, designers mentioned a number of ways in
which the TAC toolkit could shape their future design practice.
Several participants explained that they would use the kit to stim-
ulate their own reection on acceptance “not only design for a
specic goal, but also really think about how this [technology] can
be integrated in someone’s life” (P17). For P1 (with a background in
psychology), the cards would be useful for “think[ing] a bit more
broadly about the technology side of things. . . when I’m brainstorm-
ing”. Other designers mentioned that the cards helped them to
reect on their own design practice: “I’m more aware of accep-
tance as a thing that I need to consider in design. . . maybe use the
cards to make sure I was really thinking of it” (P20). Similarly, P6 (a
clinical psychologist) commented that they would use the cards to
guide design conversations in an interdisciplinary environment,
by having “these to hand in that kind of design phase to ensure that
we’re having the right conversations”. This comment implies the
need for tangible support to orientate discussion of user acceptance
within interdisciplinary settings.
Finally, although the cards were initially framed for use by de-
signers, several participants commented on the potential of the
toolkit to facilitate conversations with users in two ways. It was
described as potentially supporting the elicitation of user needs
“maybe if you bring cards with examples, they’ll start to think deeper
about these factors, they’ll realize ‘Oh, this might actually be impor-
tant for me, now that you’ve brought it up’” (P10). It was suggested
that the TAC cards might require several adjustments however (e.g.
‘with examples’) to fulll this aim of eliciting users’ needs and to
be successfully employed with users, such as “mak[ing] a simpli-
ed version, perhaps for users, that has dierent questions” (P1). An
alternative approach suggested by P3 was to employ the cards as
a means of ‘priming the conversation’ with users. Group 1’s work-
shop provided an example of what leading a conversation with the
TAC cards could look like: Designer P2 asking User P1 “Between
‘health beliefs and concerns’ and ‘self-image’ what do you think, Ali
[persona], is more critical here for you?”.
5.1.6 Adopting a more Ethical Approach to Design for Acceptance.
Researchers have more recently also begun to acknowledge the
association between technology acceptance and ethical design (e.g.
in value sensitive design [
4
]), including ethicality as a factor in user
acceptance — motivated in part by the acceleration towards digital
healthcare driven by the COVID-19 pandemic, and the enforcement
of governmental contact tracing apps [
64
,
65
,
87
]. Paska, for exam-
ple, argues that “technology acceptance models should also take into
account the ethical aspects of technology in terms of how technology
shapes the image of today’s world” [
64
]. Although the TAC cards
didn’t include this ethicality factor, the workshop activities led de-
signers to consider ethical principles while envisaging solutions to
user acceptance issues.
At each scenario step, participants were asked to think of ‘design
actions’ which might be taken to address the user’s acceptance chal-
lenges. A large number of the design choices suggested by the
groups coincided with the transdisciplinary ethical princi-
ples developed by Bowie-DaBreo and colleagues [
9
]; Transparency,
as evoked by 4 groups (e.g. “an indication of how reliable the [glucose
sensor’s] results are”, Group 4); Autonomy, mentioned by 3 groups
(e.g. “allowing user[s] to stay in control proactively (not reactively)”,
Group 3); Accessibility, recommended by 2 groups (e.g. “make the
(small) fonts adjustable so users with all requirements/ages can read
it”, Group 5); And Privacy, discussed by a single group (“noti-
cations are [kept] general to protect privacy”, Group 7). Finally, in
line with the move towards more personalized health and mental
health technologies, recommendations for more tailoring of the
technology were made across 4 groups (Groups 3, 4, 5 & 7).
5.2 Fostering Richer Reection on Acceptance
Concepts and Process
Participants discussed how using the toolkit changed their approach
to reecting upon user acceptance, through helping designers un-
familiar with the concept overcome obstacles to richer reection,
and encouraging new perspectives on user acceptance through
interdisciplinary collaboration.
5.2.1 Facilitating Reflection around Acceptance. As our participants
noted, multiple obstacles stand in the way of designers’ capacity to
reect upon and engage in discussion of user acceptance. Firstly,
technology acceptance is an ‘immense research eld’ (P11), and
the multitude of theories can prove overwhelming. By translating
these theories into a relatively concise framework, the TAC cards
created a dened space for designers to approach theoretical
constructs:
«I’ve come across 15 theories myself.. . slightly dier-
ent perspectives depending on the context. . . A set of
generalizable or standardized questions that could be
asked for general constructs that are suggested in those
dierent theories, it’s a really useful tool to have. » P16
Workshops furthermore revealed that designers lacking famil-
iarity with user acceptance often refrain from taking part in design
conversations if they feel they have ‘nothing to bring to the table’.
The TAC cards, in this regard, created a safe environment, helping
designers feel more condent in discussing acceptance: “I
could be an important part of the discussion, on equal terms with the
others” (P11). Another challenge for designers new to the concept
of user acceptance is understanding the numerous individual as-
pects of the concept: “You have to remember that there could be all
these dierent things at play” (P1). The issue here is two-fold: on
the one hand, designers might not remember all acceptance factors
and fail to address key elements in technology design; on the other
hand, they might overly focus on a subset of acceptance factors, and
overlook others relevant. Trying to remember these theories fur-
thermore adds to designers’ cognitive load. While the TAC toolkit
The TAC Toolkit: Supporting Design for User Acceptance of Health Technologies CHI ’22, April 29-May 5, 2022, New Orleans, LA, USA
helps tackle these issues, we also observed the presence of a learn-
ing curve during participants’ rst use of the cards, as reected in
P20’s comment that “initially, it was a little overwhelming.. . as time
went on, you became more familiar with them”.
The toolkit was also described as lending a concrete dimen-
sion to the concept of user acceptance, often perceived as too
abstract, by operationalizing the acceptance factors in a form easier
to grasp and apply in design: without the moderation of the cards,
when I think about user acceptance, well I think about it at a very
abstract level.. . it kind of helped navigate our thinking to one cer-
tain area in depth (P15). When participants were unsure about the
meaning of a factor, the sensitizing questions at the back of
the cards provided clarication (P2). Similarly, when a factor’s
title appeared too vague or ambiguous, designers checked their
interpretation against the questions provided: “my computer science
brain obviously assumed ‘integration’ meant compatibility across
technologies, but really it was ‘life integration’” (P3).
5.2.2 Opening New Perspectives through Interdisciplinary Collabo-
ration. The interdisciplinary setup of the groups also appeared to
benet designers’ reection, some participants reporting that the
collaboration exposed factors they hadn’t considered: “I could see
some aspects from a scenario that I wasn’t considering, that came with
the collaboration” (P19). During interview, P6 further explained how
working in an interdisciplinary group broadened their own per-
spective: “[P5] saw things a dierent way. So, it denitely widened
my perspective on how people can feel about a technology”. The value
of involving psychologists in acceptance conversations was also
underlined by P20 (clinical psychologist), particularly in order to
discern nuances in users’ behaviors and thought processes, and
identify manifestations of mental health diculties.
5.3 Supporting Conversations through a
Common Vocabulary of Acceptance
Most participants discussed the role the TAC cards specically
played in both facilitating and enriching their communication
throughout the workshops. By granting designers the necessary lan-
guage to discuss acceptance up front — and via a medium tangible,
accessible, and playful — rewarding discussions about a complex
topic were made easier. Multiple participants reported that the
cards were a conversation starter. As each group comprised
participants of varied backgrounds, there was often a gap in pre-
existing knowledge around acceptance factors. The TAC cards
quickly gave participants a shared context through which to en-
gage with one another: “The cards are like your invitation to join the
party” (P7). The cards lowered the entry point to traditionally com-
plex topics, quickly equipping designers with enough knowledge
about a given acceptance factor such that they could meaningfully
engage in discussion: “It’s easier to navigate [than models]. . . they
serve their purpose so speedily it allowed that conversation to emerge.”
(P7). Given the complexity of acceptance and the often ambiguous
terminology found within existing theory, the TAC cards serve,
conversationally, as a ground truth from which participants
could rene their understanding; P14 explaining that they were
able to agree on the importance of each factor “because all of us
shared an understanding of the factors”.
6 FINDINGS | DEDUCTIVE THEMATIC
ANALYSIS ALONG THE TEMPORAL
DIMENSION OF ACCEPTANCE
While the inductive thematic analysis (Section 5) focused on design-
ers’ experience using the TAC toolkit during the workshops, we
further explored how the toolkit supported leverage of the temporal
dimension of user acceptance by designers. This deductive thematic
analysis, anchored in the TAL timeline, investigates how the use
of the TAC toolkit supported designers in considering acceptance
throughout the user journey, negotiated the interplay between fac-
tors, and accounted for the variety of user trajectories as well as
the diculties they faced in envisaging future acceptance issues.
6.1 Considering the Question of Acceptance
throughout the User Journey
Designers reported that using the toolkit they could see the un-
folding of a user acceptance journey over time: “It kind of felt
[like] I’m going on with the user progress. . . It made me curious at this
step to know what is the next step” (P19). Considering their richness,
it can be taxing to grasp and understand the range of elements in-
uencing user acceptance and how they evolve in time. By creating
8 temporal milestones inside the user journey, and putting the set
of acceptance factors in designers’ hands, the TAC toolkit helped
participants understand the reasons behind a user’s trajectory,
and enabled them to get a richer appreciation of the complexity
of user experience. For instance, P6 described how the temporal
dimension of the scenario helped them to understand the persona
trajectory of abandonment of the technology (P6).
6.1.1 Leveraging the Temporal Continuum: Pre-Use Acceptability
— Initial Use Acceptance — Sustained Use Acceptance. Nadal et al.’s
prior review showed that user acceptance was rarely examined
at the pre-use stage [
63
]. In addition, user journeys tend to focus
on users’ interactions with the technology (e.g. patient journey
mapping looking at patients’ ‘touchpoints’ with healthcare tech-
nologies [
56
]), thus failing to consider users’ perceptions of the
technology. The TAC toolkit aimed to tackle this possible over-
sight by showing that the user acceptance journey consists of a
sequence of experiences, each susceptible to changing the
user’s perception of the technology. Participants observed this
connection when Persona Ella took on the glucose monitoring app:
Ella (P8): « Setting it all up was easier than I expected.
The sensor is attached to my stomach, just above my
hip. It’s a bit weird but it’s discreet. I’ll get used to it.. .
P9: The ‘technology anxiety’ she [Ella] has has been
suddenly reduced.
P7: Yeah, there’s a sense of ‘enjoyment’ in terms of [the
app] being initially usable, easier than expected. »
Furthermore, most studies measuring acceptance have focused
on the sustained use stage [
63
], evaluating the extent to which users
have accepted the technology after long-term use. This approach
reduces acceptance to a point measure, which does not capture the
evolution of user experience. Measuring sustained use acceptance
also requires deploying the health technology, potentially with
a clinical population. This is a more taxing process for gaining
insight into acceptance problems that could have been identied
CHI ’22, April 29-May 5, 2022, New Orleans, LA, USA Nadal, et al.
earlier in the course of design. The TAC toolkit as an exploratory
design tool, thus used at an early design stage, enabled designers
to look into prospective user acceptance issues with a system,
and understand how design choices could lead to a particular
user acceptance trajectory. P20 explained that, in the sustained
use stage of the workshop, they noticed that “[the persona] is still
in the same [problematic] place: what does that mean?”. They then
reected on the acceptance factors the group had agged as relevant
in the previous steps of the user journey: “we had picked that before
and now he [the persona] is here. So, you know, what do we need to
think of for the technology?”.
6.2 Negotiating the Interplay among Factors
Inuencing Acceptance
The weight of each acceptance factor varies throughout the user
acceptance journey [
63
], some proving more pertinent at the pre-use
stage, and others having greater impact at the point of long-term
use. The multi-choice scenario gave designers the opportunity to
explore dierent trajectories for the same persona, depicting various
issues of acceptance. Each group’s nal think-space provided a
visualization of the trade-o between acceptance factors —
as reected in Fig. 6 which shows how the user’s ‘anxiety’ is rst
reduced by their ‘enjoyment’, but later exacerbated by the system
‘usability’ and the person’s lack of ‘trust’. Complementarity between
acceptance factors was also rendered visible, making explicit the
complex nature of some acceptance issues. The notes taken by
Group 6 reect the interdependency between the cards ‘healthcare
professional relationship’, ‘trust’ and ‘self-image’ selected: “We
pick the cards because the app is sharing Ali’s [the persona] little
secrets with the doctor and she feels upset, as she thought it was
going to be a useful tool”. Finally, creating new meaning through
the think-space’s virtual elements, some participants represented
the interplay between factors by overlaying cards on the board:
«P1: It’s like both [factors] overlayed on top of each
other. . . it’s maybe more ‘health beliefs and concerns’
because... Oh I don’t know yeah, it’s kind of both...
P2: We can maybe put one [card] on top of another, like
showing that they overlap? »
6.3 Accounting for the Variety of User
Trajectories when Considering Acceptance
The user journey with technology is rarely linear — intermittent or
discontinued use proving common issues, particularly in the health-
care context [
61
,
80
]. It is essential therefore that design accounts
for the variety of experiences across the full user journey. However,
User Experience models tend to provide punctual representations
of the user journey [
93
], or tend to adopt an optimistic view of
the user’s experience, failing to capture how a technology can be
abandoned at any stage in the user journey — even before the rst
use [
43
]. Being able to explore the user journey through temporal
windows, and also from both more and less optimistic perspec-
tives, helped designers envisage various possible user trajectories.
P17 (who played the persona) reected on the activity of selecting
a storyline among the three available at each scenario step: “I found
it quite useful to have these scenarios, to see how things could go”.
6.4 The Diculty of Envisaging Future
Acceptance Issues
Velt et al.’s review found that “taking into account trajectories
helped with the design of future experiences” as “trajectories raised
novel design requirements for a class of experiences” [
93
, p. 2095].
During the workshop, participants worked with prospective user
trajectories, in a near or distant future, which enabled them to de-
sign for possible future issues regarding acceptance. Although
most designers are familiar with reecting on users’ past experi-
ences, envisaging future experiences — especially distant ones —
was for many both novel and challenging. Two aspects of the design
task threw o some participants.
Firstly, the length of the time scale negatively impacted designers’
ability to envision users’ trajectories, particularly those distant in
time: “It’s very hard for me to take that whole year-long view.. . the
ask was getting too ne-grained on something [a user trajectory]
that’s more sketchy” (P18). To address the diculty of working with
a detailed view of the long-term user journey, P18 suggested an
iterative approach where designers would rst “try and get the
basics down and move on to the next one [scenario step]” before
“zoning in on each one [step] to go more in depth”.
Secondly, some participants commented on an impression of
a too rapid passing of time, which was materialized by the time
intervals between each scenario step: “Even though you actually had
‘1 week’, ‘3 months’, ‘1 year’.. . it was a bit fast in some sense” (P11).
The granularity of the time intervals was mentioned as a possible
explanation: “the temporal side wasn’t quite the right granularity
(P5). Thinking back on the group’s design ideas for addressing fu-
ture acceptance issues, P11 spoke of recognizing greater substance
in latter parts of the journey: “There was a lot more to discuss some-
how.. .because now the user has been using it [the system]. . . it will
be interesting to have even more snippets of stories in that area”.
7 DISCUSSION
Findings indicate designers’ overall enjoyable experience of en-
gaging with the TAC toolkit and its playfulness as facilitated in
particular by the cards. We now reect on the value of the TAC
toolkit, for supporting reection on and design for acceptance from
a macro-temporal perspective, and discuss its impact on designers’
knowledge, values, and behaviors, with a focus on intentions to
change future design practice.
7.1 Revising & Extending Knowledge of the
Technology Acceptance Process: Dynamic,
Multi-stage, Complex
Findings indicate that the TAC toolkit prompted designers to change
the way they think about acceptance. The toolkit and its method
supported participants in gaining richer design knowledge of ac-
ceptance in three main directions.
Firstly, it helped them uncover and challenge inaccurate assump-
tions that acceptance is a static process with limited temporal quali-
ties rather than a dynamic one to be best understood from a macro-
temporal perspective. Thus, our ndings extend those on user ex-
perience frameworks focusing on discrete experiences [
31
,
55
] and
The TAC Toolkit: Supporting Design for User Acceptance of Health Technologies CHI ’22, April 29-May 5, 2022, New Orleans, LA, USA
Figure 6: The think-space generated by Group 3, showing their notes on the negotiation of 4 factors: technology anxiety,
enjoyment,objective usability, & trust, across the 3 temporal milestones of the initial use acceptance stage. Elements of interest
are in bold.
those that change in time [
44
] by integrating a theoretically in-
formed macro-level temporal perspective of technology acceptance
[
26
]. We have introduced a novel type of scenario — which we call
temporal multi-choice scenarios — that we designed to embody such
a macro-temporal perspective through the eight temporal mile-
stones across the three stages of the TAL acceptance process [
63
].
Unlike the traditional scenario depicting situated use of technology
at a single and usually indeterminate moment in time, our approach
marked a signicant shift accounting for the temporal dynamic of
user acceptance process, thus going beyond individual experiences
to experiences changing in time. We dene temporal multi-choice
scenarios as a sequence of scenarios capturing the evolution of users’
interaction at a macro-temporal level, from acceptability and initial
acceptance to sustained acceptance, while also providing the choice
of exploring low, medium or high degrees of challenge in relation
to dierent acceptance factors relevant at each temporal milestone.
To visually represent these scenarios we employed the concept of
interactional trajectories [
7
] via the TAC website (Fig. 4) which
we further tailor as interactional acceptance trajectories. We dene
these as visual representations of richer trajectories extending over
space and time, and in particular across the 8 temporal milestones
of the TAC toolkit, involving specic user groups engaging with a
target technology.
Secondly, ndings showed how such toolkits could challenge
the assumption that acceptance is a simple one-stage process, no
longer relevant once the technology starts being used. In other
words, it helped revise designers’ mental model of acceptance as a
multi-stage process, as argued by a wealth of theoretical models [
24
,
32
,
52
,
70
,
80
,
85
,
89
], whose relevance for design practice has been
less explored. In particular, ndings indicated participants’ richer
understanding of the importance of considering in design the other
stages of acceptance, stretching both before and after the initial use
stage within the TAL model [63].
Third, the method explored provided an engaging and accessible
operationalization of the rather complex acceptance process and
its rich set of factors from self-image [
98
], computer anxiety [
95
]
or demographic traits [
99
], to health beliefs and concerns [
46
],
and trust [
23
]. This is a key outcome towards bridging the theory
of acceptance and design practice, given that most of the work
on acceptance has overlooked many of the validated acceptance
factors [
63
]. The cards ensured more than mere communication of
information regarding these factors, but also deep engagement and
constructivist learning of factors’ meanings, and more importantly
their complementary or compromising aspects when applied to the
situated richness of the selected persona and scenario.
7.2 Sensitizing towards Designing for
Acceptance: Appreciation, Empathy & Ethics
Findings have also shown how the TAC toolkit and its method
impacted on designers’ values, sensitizing them towards the appre-
ciation of the dynamic, multi-stage and complex acceptance process,
eliciting empathy for the long-term users of health technologies,
and helping them unpack additional ethical issues when designing
for acceptance. Our rich qualitative ndings revealed that designers’
appreciation of the acceptance process was underpinned by cogni-
tive emotions of curiosity, surprise, insight, and realization [
77
,
78
].
Apart from the cards and their sensitizing questions, the method
requiring the review and selection of relevant cards per temporal
milestone of the scenario was key to developing such appreciation.
Empathy was supported by the rst-person narrative form of the
scenarios, and in particular by our choice of role-play. Participants
also unpacked important ethical concerns, and were prompted to
CHI ’22, April 29-May 5, 2022, New Orleans, LA, USA Nadal, et al.
reect on the design actions which might address the identied
diculties in acceptance of these technologies. Their rich answers
reected ethical principles of transparency,autonomy,accessibil-
ity, or privacy, which are key for health technology design [
9
,
72
].
While traditional exploratory design methods in general, and those
employed for sensitive contexts like health [
36
,
74
,
92
,
101
,
103
],
have long acknowledged the signicance of fostering empathy and
ethical values, they have focused mostly on discrete user experi-
ences rather than continuous experiences as entailed in long-term
acceptance and its macro-temporal perspective.
7.3 Impacting Future Design Practice
In addition to helping designers change how they think and feel
about designing for long-term acceptance of health technologies,
our ndings suggest the value of the TAC toolkit as a means of
changing designers’ future practice. Participants’ expressed desire
to use the toolkit in their future practice is a signicant outcome,
given that intended behavior change is an indicator of transforma-
tive learning as highlighted within several models of reection [
57
].
Interestingly, the perceived ease of use of the TAC toolkit made it
an attractive design tool envisaged also for use with other stake-
holders, and importantly, with future users in early stages of the
design process. Traditional exploratory design methods intended
to bridge the design gap [
76
] such as personas [
51
], scenarios [
106
],
design cards [
8
], or toolkits [
48
] have focused predominantly on the
design of technologies for the initial use stage, with limited focus
on the pre-use, and sustained use stages. Our ndings, however,
increased participants’ awareness of change at two levels: change
in users’ needs over time, and change to their personal constellation
of relevant determinants of technology acceptance. Together, these
changes support a broader and more exible set of requirements
for technology design.
7.4 Implications for Design Research
We now reect on the implications for design research entailed in
our ndings. We discuss the value of integrating design tools to
better support the bridging of acceptance theory and design practice,
of considering the evolution of acceptance factors and how the TAC
toolkit may also evolve over time, and for more tailored support for
designers to imagine future experiences in the sustained use stage.
7.4.1 Integrating Design Tools for Bridging Acceptance Theory and
Design Practice. Findings indicate the value of the TAC toolkit for
articulating and leveraging theoretical HCI work on technology
acceptance in order to better inform the design for acceptance of
health technologies. The signicant need within HCI for bridg-
ing the gap between theory and design practice has been long
acknowledged, and eorts to address it have led to conceptual con-
tributions, such as translational resources [
13
,
14
], intermediate
design knowledge, strong concepts [
39
], bridging concepts [
17
],
boundary objects, [
94
], or implications for design [
76
]. However,
despite the progress made at a conceptual level and the wealth of
traditional design tools, those for better bridging the gap are still
much needed. We argue that the value of the TAC toolkit resides
in the integration of exploratory design methods, such as personas
and scenarios, with the TAC cards, and within the think-space and
website. While personas and scenarios have been traditionally cou-
pled in design research [
16
,
25
], our ndings suggest the added
value of integrating these with acceptance theory, operationalized
through the TAC cards and their sensitizing questions.
7.4.2 Considering the Evolution of Acceptance Factors in Designing
Tools for Acceptance. Another implication for design tools support-
ing long-term acceptance of health technologies is accounting for
how the factors of acceptance may change over time. This has been
reected in the evolution of acceptance models, moving from a
focus on technologies for the workplace [
20
,
21
,
88
,
95
,
96
,
98
,
99
],
through pervasive technologies [
15
,
100
], to healthcare technologies
[
23
,
27
,
41
,
46
,
79
]. Our ndings also provide empirical support for
ethicality as an emerging antecedent of user acceptance [
64
,
65
,
87
].
This is a clear indication that, while the TAC cards comprise an
eective capturing of today’s most relevant antecedent factors, they
will benet from future revisions in order to align with evolving
technologies and their users’ needs. The TAC toolkit is itself nally
a key contribution of this work, which we make available to de-
signers and researchers for adoption and adaptation to the unique
context of their own health technology designs.
7.4.3 Supporting Design for Long-Term Acceptance. Unlike the ex-
ploration of user acceptance challenges before and at the early
stages of use of the technology, considering distant user acceptance
issues (in the sustained use stage) proved challenging. This related
to the less familiar task of envisioning the long-term evolution of
user experiences. Despite these challenges, designers appreciated
the importance of such future experiences, and highlighted the
value of a longer design activity to address those. Previous nd-
ings in cognition research showing that future events can be better
imagined and pre-experienced when they are positive, and rich
in sensorial details [
28
], we can imagine temporal multi-choice
scenarios that are likewise richer in sensorial details to support
designers in this task.
7.5 Future Work
This study investigated one specic context and procedure of use of
the TAC toolkit. Future work will explore other possible directions,
such as (a) adopting the same scenario-based method as a peda-
gogical exercise for elevating designers’ knowledge, (b) using the
toolkit in the process of designing specic real-world technologies,
shaping and orienting designers’ reections, and (c) as a resource to
be used in user-centered research methods (e.g. interviews with real
users). The diversity of the TAC personas and scenarios addition-
ally facilitate their tailoring to other digital health contexts worth
exploring, from mindfulness [
18
,
19
] to dementia [
73
] or chronic
physical conditions. As suggested by P12, there might furthermore
lie value in developing a new tool to support creation and elabora-
tion of temporal user acceptance scenarios. Finally, future research
might consider adapting the TAC toolkit for use outside the health-
care context, to better support design for technology adoption from
a macro-temporal perspective.
8 CONCLUSIONS
We report the design and evaluation of the TAC toolkit, a novel
theory-based design tool and method, with the aim of exploring
The TAC Toolkit: Supporting Design for User Acceptance of Health Technologies CHI ’22, April 29-May 5, 2022, New Orleans, LA, USA
how user acceptance theory can be leveraged in the design of health
technologies. Findings showed that, through playful engagement,
the toolkit revised and extended designers’ knowledge of technol-
ogy acceptance, fostered their appreciation, empathy and ethical
values while designing for acceptance, and motivated its future use
in their design practice. Finally, we discussed implications for con-
sidering user acceptance a dynamic, multi-stage process in design
practice and better supporting designers in imagining distant user
acceptance challenges, and we considered the generative value of
the TAC toolkit and its possible future evolution.
ACKNOWLEDGMENTS
This work has been jointly supported by AecTech: Personal Tech-
nologies for Aective Health, Innovative Training Network funded
by the H2020 People Programme under Marie Skłodowska-Curie
(grant 722022), the Science Foundation Ireland Centre for Research
Training in Digitally-Enhanced Reality (d-real, grant 18/CRT/6224),
and the Novo Nordisk Foundation (grant NNF16OC0022038). This
work also received the nancial support of Science Foundation Ire-
land (ADAPT, grant 13/RC/2106_P2, and LERO, grant 13/RC/2094_P2).
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A APPENDIX
Figure 7: Temporal multi-choice scenario for the persona Alex (COVID-19). Each of the 8 temporal milestones presents 3 paths,
each exploring acceptance issues of high, medium or low degrees of challenge. The milestones of seeking advice and choosing
technology (situated before technology use) present 3 neutral paths, as acceptance issues are yet to arise.
