Health Resilience Interactive Technology: transforming self-management for individual and community health via inbodied interaction design

We urgently need proactive health support at the level of the general population: we have become, on average, an unhealthy nation. The new statistical norm is overweight to obese (60% of men and 49% of women). Co-related conditions from heart disease to type II diabetes, cost the NHS £48 Bn/year. Lack of sleep costs £40Bn. Stress costs £40Bn. 6% of our GDP goes to preventable "lifestyle conditions." Of the top 20 western nations, the UK ranks 18th or lower in QoL, Health, Wealth, Education and Democracy. Our productivity is 20% lower than the rest of the G7.

While there is incredible optimism and investment in the potential benefits of ubiquitous, pervasive technology to help redress these conditions, digital health approaches to date have had low impact. This fellowship hypothesises that the lack of broad and sustained uptake of digital health technology is not a fault of the technology per se but with the range of models that inform how these technologies are designed. The current state of the art in digital health tech is (i) targeted at individuals although health practices are significantly influenced by social contexts; (ii) it assumes that given the right data we will make a rational decision to adopt a health practice without taking into account how the rest of our bodies - from our gut to our nervous system - is involved in decision processes (iii) the tools themselves can be antagonistic to rather than supporting of how the body works. E.g. a "smart alarm" that still disrupts sleep rather than finds ways to help us get sleep is antagonistic to our physiology which requires certain amounts of sleep to stay healthy.

While current digital health technologies can and do work for some of the people some of the time, they have not been sufficient to deliver health in the complex contexts in which the UK lives and works. We need to develop better models to inform health tech design. This fellowship proposes to develop and test Inbodied Interaction (the alignment of health tech with how the body optimally performs) as a foundation to deliver and sustain personal and social Health Resilience: the capacity for individuals and their groups to build health knowledge, skills and practice to recover from and redress health challenges, from stress at home to shift changes at work.

In line with EPSRC's challenge to "transform community health" by enabling better "self-management," digital interactive technologies must be aligned with how we work as organic-physical-cognitive-social complex systems. In respect of that model of "self" the fellowship will innovate on three strands of inbodied interaction technology:
1) Environment-Body Aligned: designing technology to support our physiology, from displays that help us maintain peripheral vision to stay more creative, to light use in VR lenses to improve cognitive performance.
2) Experience-to-Practice Aligned: to provide rapid access to the effects of better health experiences, and connect these with personally effective means to maintain these.
3) Group-to-Culture Aligned: to support groups identify and build more health resilient practices that work for their contexts.

Thus "self-management" is transformed into our 3-level model of how this "self" is empowered by health tech in various contexts to create build and maintain "health." Through our co-design we will be engaging directly with hundreds of participants, and thousands more citizens virtually through our nation-wide Citizen Scientist web trials. We also have regular engagement with our expert advisory team representing industry, policy, and a range of disciplines. The Team is committed to help translate our work from project to practice, from policy to process, for transformational impact. By Fellowship end, we will have new digital health technologies and validated models for those tools to deliver Health Resilience for a Healthy Nation, and so help #makeNormalBetter@scale, for all.

IMPACT: PEOPLE
People on the trials:

A critical point of contact and impact are the numbers and qualities of the participant groups with whom we are working, including nurses, teachers, college students, medical students, volunteer carers. We have so many groups of people via our project partners who have agreed to work with us because they not only want to feel and perform better and gain the agency to do that, they want to support that for their communities. To this end, the fellowship program is designed from day one to support and improve participant wellbeing. Over the course of the fellowship in our deployments alone we will have engaged with over 3000 people directly and possibly tens of thousands via our online Citizen Science web studies. Unlike Randomised Controlled Trials where some groups may receive no support, no help, our approach insures when we are exploring different designs, everyone still participates in learning skills and being supported.

People in similar groups:

By using an In the Wild methodology (deploying our technologies in real environments), working with people to explore building resilient health approaches with us, as we test our ideas across diverse groups, we will gain deeper insights into core features that deliver most benefit for most groups. In exchange, our participants will also learn health resilient practices as they test our tools to build health resilient practices. Part of our research is to understand the ways to evaluate success of these interventions both immediately while using the tools, and over time, as tool use may decline or change. Because of the scale and diversity of the co-design and deployments we will run in the fellowship, we will demonstrate the scalable efficacy of our tool deployments.

People in broader society - everyone:

The Advisory Team and associated participant groups have been put together deliberately to optimise both understanding of how to design inbodied interaction based digital health technology for national benefit, but also to have best opportunity while being developed to have impact nationally, towards a vision to use these approaches to make normal better and healthier for the UK. The main focus of these groups, however, is not "us" as in the people reading and assessing these proposals, but the general public where the average salary for a woman is £25K and average for a man is £30K; where people on average are chronically stressed, overfed but malnourished, underslept and both time as well as cash poor. By focussing on students on the one hand and people who care for people on the other (and where we have overlap across both), the fellowship focuses on people best placed to create a better normal for more of the UK, right now, today. Because we are working with policy makers as well from Day One, we will be developing best paths for these tools to be taken up in as many contexts as possible.

IMPACT: PUBLIC HEALTH - #makeNormalBetter@Scale - for all
Public health programs from sanitation to vaccinations to laws to prevent smoking in public are all clearly evidenced as effective in making normal better. There are many areas of health and wellbeing, however, that still require individual and cultural shifts. By designing technologies that enhance performance aligned passively, by creating access to experiences of health quickly, by empowering groups to test and design better health cultures, we complement these larger scale efforts. A key outcome of our work in inbodied interaction is to deliver the socio-digital foundations necessary to build and sustain health resilience at a national policy or public health scale - to help #makeNormalBetter for all. This fellowship is in particular a deliberate effort to create the digital technology and models for bottom up approaches for individual and group tuning to support health, wellbeing and human performance, that together will enable better health at scale.