Sex differences in cystic fibrosis (CF) affect symptom manifestation, severity, and life expectancy. Female hormonal fluctuations, both cyclical and lifelong, can exacerbate lung function issues, increase susceptibility to chronic infections, and lead to earlier mortality. With recent advances in modulator therapy, people with CF are living longer and encountering later phases of female sexual and reproductive health (SRH), from pregnancy to menopause. This longevity introduces new convergences between SRH and CF management. While technological innovations have begun to address aspects of female SRH and chronic condition management, they often overlook the unique complexities of these intersecting issues. Our qualitative study examines the experiences of people with CF across different female SRH, from menstruation to menopause, exploring their daily challenges and interactions with care. We discuss pluralistic approaches to FemTech, online communities, AI, and clinical technologies, providing implications for technologies to address the complexities of the intersection of CF and SRH.

Traditionally conducted in person, user research is increasingly shifting to remote methods that leverage everyday communication technologies. Although video conferencing platforms such as Zoom have proved successful in supporting distributed user research, they also pose challenges for low resource settings, including high costs, scalability concerns, and the need for stable internet connectivity. In response, we explore how widely adopted alternative mobile messaging platforms might support flexible, on-the-go, and accessible research. Using WhatsApp as a user study platform, we conducted a two-year study on designing technologies for collaborative Type 2 diabetes (T2D) care in Port Harcourt, Nigeria. We conducted interviews, surveys, design workshops, and think-aloud prototype evaluations with 112 participants in total. We found that while WhatsApp can effectively support diverse research activities, its use requires adaptable study designs that accommodate app updates and participant preferences. This paper provides practical guidance on using mobile messaging platforms like WhatsApp for user research, including mitigating ethical risks, fostering multimodal interaction, and managing disruptions and participant dynamics. We argue that leveraging popular mobile platforms is an ethical, inclusive, and situated approach that might broaden participation in the design and evaluation of interactive technologies. • Distributed research methods for understanding lived experiences using WhatsApp. • Mobile messaging applica:ons support data collec:on in low resource regions. • WhatsApp can be used for interviews, surveys, design workshops and think-aloud protocol sessions, but with certain considera:ons. • Provides a framework for human-computer interac:on and social science researchers to facilitate data collec:on across a large group.

Culturally sensitive design is crucial for developing inclusive technologies, particularly in resource-constrained settings. However, such approaches often oversimplify culture and face challenges in cross-cultural relevance. This study addresses these issues by exploring how participatory design can be both culturally grounded and adaptable across subcultures within African communities. We conducted 13 distributed design workshops with 19 participants, including people with Type 2 Diabetes (T2D), caregivers, and pharmacists, from diverse ethnic groups in Port Harcourt, Nigeria. These workshops informed the design of a mobile health prototype featuring interactive flows in Pidgin English, collaborative care tools, peer support groups, and a calorie prediction feature. The prototype was evaluated by 30 participants through think-aloud sessions and interviews. Findings highlight that while some features aligned with local cultural norms, others were less effective across sociocultural boundaries, even within the same city. We offer insights and methodological guidance for developing digital health tools that are locally relevant and regionally adaptable.

Self-managing chronic conditions typically involves a diverse network of individuals and devices, forming a self-management ecosystem. For this ecosystem to be effective, components need to work together cohesively. The rapid advancement of technology means new devices need to be repeatedly integrated into existing self-management ecosystems. To examine this process, we used the case study of young adults with type 1 diabetes (T1D) in the UK who were given a smartwatch. Over six months, interviews and focus groups were performed to explore their smartwatch use alongside T1D management. Thematic analysis highlighted that smartwatches have potential as a display, interface and data source in T1D management, which is of particular importance as artificial intelligence plays a growing role in self-management ecosystems. It also emphasised the need for customisation, flexibility and adaptability, and automation in the design of technology to promote integration into existing self-management ecosystems for both T1D and other chronic conditions.

Consumer technology is increasingly used to support the self-care of atrial fibrillation (AF), a chronic heart condition that affects physical, emotional, and mental health due to its unpredictability, symptoms, and complications. Through interviews with 29 adults self-tracking while living with AF, we found that consumer technology enabled participants to outsource bodily awareness to their ’digitised heart,’ facilitating innovative pill-in-pocket interventions and empowering negotiation in shared decision-making. Drawing on phenomenology, we introduce ’Bodily Doubt’ to explain how uncertainty about the body shapes the use of technology in chronic illness and how the use of technology influences uncertainty. Technology mediates ’Bodily Doubt’ both by providing reassurance and exacerbating it, particularly when technology fails to adapt to disease progression. Our findings have implications for understanding how technology influences the lived experience of illness, challenging experiential concepts of lived experience in self-tracking and design that foregrounds the experience of the lived body.

To reach net-zero greenhouse gas emissions by 2050, the UK government is replacing domestic gas boilers with heat pumps, necessitating an understanding of the challenges faced by users in adopting this new technology. We surveyed 50 early adopters of heat pumps and conducted 23 follow-up interviews to explore their experiences of installation and adaptation. Using Thematic Analysis, we identified key themes within the framework of social practice theory, highlighting important implications for enhancing heat pump installation and adoption processes. Our findings suggest that improved infrastructural support, user education, and adaptive design can enhance engagement and satisfaction, shaping future policy and design strategies for renewable home energy systems. We aim to further understanding on the complexities of heat pump adoption and offer strategies to support a smoother transition to sustainable heating within the home.

Paper-based journaling remains ubiquitous and provides significant potential to support mental wellbeing and inform the design of digital mental health interventions. However, it remains unclear how tangible tools can be designed to facilitate creative and artistic journaling practices. We present the design and evaluation of a tangible toolkit comprising a set of laser-cut stencils and an example-based how-to guide on self-tracking mood through mindful colouring. Drawing on the findings of a two-week field study with university students from diverse backgrounds, we demonstrate how the tangible toolkit scaffolded personally meaningful expression of mood and lived experience. Participant’s visual accounts illustrate creative stencil appropriation and individual colouring preferences in documenting and understanding mood, emotions, and feelings in daily life. Based on this understanding, we suggest shifts towards more tangible mental health approaches to support people in expressing and exploring their felt experiences in creative ways.

The high prevalence of Type 2 Diabetes in Nigeria demands sustained community care involving complementary care providers, pharmacists, primary healthcare providers, and caregivers. However, there is limited information on the collaborative provision of T2D care among these stakeholders, the contextual factors affecting their roles, and their use of technology. Recognizing the role of caregivers, the accessibility of pharmacists in communities, and the vital contributions of collaboration to long-term disease care, this study adopts an Afro-Centered approach using Port Harcourt, Nigeria, as a case study to generate insights into collaborative care and identify design opportunities. By engaging with 51 participants, we explored the context-driven nature of diabetes care, including the socio-cultural influences on pharmacists, families, and access to health information. Our findings highlight current diabetes care practices and underscore the importance of tailoring digital interventions to address these contextual needs.

The menopause transition has a direct impact on half of the global population, yet it has continued to be a stigmatised topic with limited focus on supporting it with technology. Whilst attention being given to menopause in HCI may be new, people experiencing it is not and people have adopted, adapted and appropriated technologies to support their menopause journey. In this questionnaire and interview study, we examine how people in the UK are using (and not using) existing general and menopause-specific technology to support themselves through the transition. Despite limited menopause-specific technologies available, participants have found novel uses of technologies such as social media and smartwatches for 1) connecting and sharing, 2) information seeking, 3) tracking and reflecting, and 4) self-care. This work contributes design considerations for menopause specific technologies, and design opportunities and challenges for technologies that can be appropriated to support menopause.

Despite their nonclinical origins, wearables are emerging as valuable tools in supporting the diagnosis of cardiovascular disease, one of the leading causes of death worldwide. Diagnostic data once only available via a cardiologist is now available to consumers simply by wearing a smartwatch, so understanding how smartwatches currently support diagnosis is important for healthcare providers and for the designers of increasingly sophisticated personal informatics technology. We conducted a qualitative study comprising interviews and analysis of posts on an online community of accounts of smartwatch assisted cardiac diagnosis. Our findings reveal how smartwatches bridge a current gap in clinical diagnostic modalities, facilitating a diagnostic journey instigated and shaped by the interplay of self-collected data, bodily self-awareness, and increasing clinical acceptance. These insights focus attention on the consequences of the democratisation of health data, with ethical and design implications for health providers, consumer electronic companies, and third-party application designers.

Engaging end user groups with machine learning (ML) models can help align the design of predictive systems with people's needs and expectations. We present a co-design study investigating the benefits and challenges of using computational notebooks to inform ML models with end user groups. We used a computational notebook to engage young adults, carers, and clinicians with an example ML model that predicted health risk in diabetes care. Through co-design workshops and retrospective interviews, we found that participants particularly valued using the interactive data visualisations of the computational notebook to scaffold multidisciplinary learning, anticipate benefits and harms of the example ML model, and create fictional feature importance plots to highlight care needs. Participants also reported challenges, from running code cells to managing information asymmetries and power imbalances. We discuss the potential of leveraging computational notebooks as interactive co-design tools to meet end user needs early in ML model lifecycles.

Home health monitoring systems (HHMS) are presented as a cost-effective solution that will assist with collaborative care of older adults. However, instead of care recipients feeling like collaborators, such systems often disempower them. In this paper, we examine the dissemination, onboarding, and initial use of an HHMS to see how the discourse used by developers and participants affects users’ collaborative care efforts. We found that the textual information provided often contrasted with how our participants managed their care. Instead of providing participants with ‘independence,’ ‘safety,’ and ‘peace of mind,’ care recipients were placed in a more dependent, less proactive role, and care providers were pressured to take on more responsibilities. We position HHMS, as they are currently marketed and onboarded, as normalizing pseudo-institutionalization. As an alternative we advocate that the discourse and design of such systems should reflect and re-enforce the varied roles care recipients take in managing their care.

Social virtual reality (VR) platforms have increased in popularity with many people turning to these platforms to experience social connection, including a rapid influx of users during the COVID-19 pandemic. However, there is limited understanding of how people appropriate and use emerging social VR applications to actively support their mental health and wellbeing in daily life. Through an online questionnaire and exploratory interviews conducted within the social VR app VRChat during the COVID-19 pandemic, we document how social VR is being used explicitly as a mental health support tool. Participants reported positive wellbeing benefits, mostly attributed to the anonymity provided by avatars and perceived safety within digital worlds and communities of practice. We also report how people use social VR to practice social interaction, reduce negative thoughts and form strong social bonds and connections with others.

Self-managing a chronic condition involves adapting management strategies to life’s continual change. Among these changes, moments of significant life transition can render routine self-management practices obsolete without significant modification to the new context. In this study, we examine one significant life transition for young adults living with Type 1 Diabetes, the move from home to university, to understand how near future AI-enhanced technologies might provide opportunities and challenges for supporting care. From interviews with 24 students in the UK who had moved away from their childhood homes, we used sensemaking literature to frame the process of initial disruption to the rebuilding of self-care practices around a new lifestyle and support networks. By studying a significant life transition, we uncover implications for the design of T1D technology, particularly closed-loop systems, through AI enhancements and human-centred design approaches, then extrapolate for other significant life transitions and chronic conditions.

Whilst the use of smart home systems has shown promise in recent years supporting older people's activities at home, there is more evidence needed to understand how these systems impact the type and the amount of shared care in the home. It is important to understand care recipients and caregivers' labour is changed with the introduction of a smart home system to efficiently and effectively support an increasingly aging population with technology. Five older households (8 participants) were interviewed before, immediately after and three months after receiving a Smart Home Health System (SHHS). We provide an identification and documentation of critical incidents and barriers that increased inter-household care work and prevented the SHHS from being successfully accepted within homes. Findings are framed within the growing body of work on smart homes for health and care, and we provide implications for designing future systems for shared home care needs.

Type 1 Diabetes (T1D) self-management requires hundreds of daily decisions. Diabetes technologies that use machine learning have significant potential to simplify this process and provide better decision support, but often rely on cumbersome data logging and cognitively demanding reflection on collected data. We set out to use co-design to identify opportunities for machine learning to support diabetes self-management in everyday settings. However, over nine months of interviews and design workshops with 15 people with T1D, we had to re-assess our assumptions about user needs. Our participants reported confidence in their personal knowledge and rejected machine learning based decision support when coping with routine situations, but highlighted the need for technological support in the context of unfamiliar or unexpected situations (holidays, illness, etc.). However, these are the situations where prior data are often lacking and drawing data-driven conclusions is challenging. Reflecting this challenge, we provide suggestions on how machine learning and other artificial intelligence approaches, e.g., expert systems, could enable decision-making support in both routine and unexpected situations.

Explaining health technology platforms to non-technical members of the public is an important part of the process of informed consent. Complex technology platforms that deal with safety-critical areas are particularly challenging, often operating within private domains (e.g. health services within the home) and used by individuals with various understandings of hardware, software, and algorithmic design. Through two studies, the first an interview and the second an observational study, we questioned how experts (e.g. those who designed, built, and installed a technology platform) supported provision of informed consent by participants. We identify a wide range of tools, techniques, and adaptations used by experts to explain the complex SPHERE sensor-based home health platform, provide implications for the design of tools to aid explanations, suggest opportunities for interactive explanations, present the range of information needed, and indicate future research possibilities in communicating technology platforms.

A detailed understanding of the mental health needs of people from refugee backgrounds is crucial for the design of inclusive mental health technologies. We present a qualitative account of the digital mental health experiences of women from refugee backgrounds. Working with community members and community workers of a charitable organisation for refugee women in the UK, we identify social and structural challenges, including loneliness and access to mental health technologies. Participants' accounts document their collective agency in addressing these challenges and supporting social connectedness and personal wellbeing in daily life: participants reported taking part in community activities as volunteers, sharing technological expertise, and using a wide range of non-mental health-focused technologies to support their mental health, from playing games to supporting religious practices. Our findings suggest that, rather than focusing only on individual self-care, research also needs to leverage community-driven approaches to foster social mental health experiences, from altruism to connectedness and belonging.

The COVID-19 2020 lockdown measures altered how families spent time together, with many fathers adopting new household roles and spending more time with their children. This paper contributes an empirical account of technology use and fatherhood during the COVID-19 pandemic, and draws implications for the design of technologies to support fathers. We outline the findings from semi-structured interviews carried out with fathers during lockdown in the UK. Initial interviews (n=19) highlighted challenges in screen viewing, family dynamics, idea generation and self-care. This informed the design of four prototype apps to enrich follow-up interviews (n=12), using these prototypes as prompts to explore the emergent challenges in more depth. The interviews identified significant changes and concerns related to technology use within the context of COVID-19, with new roles for fathers conflicting with traditional ones combined with situational stressors to amplify issues with guilt, shame and self-care related to technology use.

Although the use of voice assistants to support older adults at home shows promise, little is known about how the next generation of these devices, which also include displays, can support health and care needs. This question has become more important during COVID-19, when issues of social isolation for older adults have been exacerbated. During social distancing measures in the UK, eleven older adult households (16 participants) were interviewed before receiving an Amazon Echo Show, shortly after receiving it, and after three months of use. We identify ways in which this multi-modal device is used by people in social isolation to support social, care, and information needs in the home. We frame these findings within the growing research area of smart homes for health and care, and provide implications for the adoption, use and acceptance of these devices to support aging in place together.

Gaining an understanding of people's diverse mental health needs is essential for informing the design of inclusive mental health technologies. However, conversations about mental health experiences can be challenging for both researchers and participants. We present the design of visual cards that illustrate an inclusive mental health concept to support researchers and participants in understanding and sharing mental health experiences. We illustrate the iterative design of the visual cards with our reflections and feedback from ethnically diverse participants. We found that designing the visual cards fostered insightful reflections within the design team regarding the roles of identity, gender, and ethnicity in designing culturally sensitive content and research. Participants from minority ethnic backgrounds valued the illustrative elements of the visual cards and highlighted the importance of supporting different languages and visual cultures. We discuss use cases for the visual cards and implications for designing culturally sensitive mental health technologies.

Co-design is a widely applied design process with well-documented values, including mutual learning and collective creativity. However, the real-world challenges of conducting multidisciplinary co-design research to inform the design of self-care technologies are not well established. We provide a qualitative account of a multidisciplinary project that aimed to co-design machine learning applications for Type 1 Diabetes (T1D) self-management. Through interviews, we identify not only perceived social, technological and strategic benefits of co-design but also organisational, translational and pragmatic design challenges: participants with T1D experienced difficulties in co-designing systems that met their individual self-care needs as part of group activities; HCI and AI researchers described challenges resulting from applying co-design outcomes to data-driven ML work; and industry collaborators highlighted academic data sharing regulations as cross-organisational challenges that can impede co-design efforts. Based on this understanding, we discuss opportunities for supporting multidisciplinary collaborations and aligning individual health needs with collaborative co-design activities.

Stairlifts are a widely-used technology in the home that help people with mobility issues to go up and down stairs. However, it is unclear how stairlifts are experienced by all household members and what this understanding implies for home healthcare technologies. We investigated the impact of stairlift installations on older adults' households in the UK through a qualitative study investigating the lived experience of the adoption and acceptance of this technology. Interviews and focus groups with primary users, household residents and service providers showed how the wider household identify misalignments between simplified stairlift installation models from service providers and describe a more complex, nuanced emotional journey which involves decision making, conflict and trauma and catharsis and independence. Findings provide transferrable outcomes for the smart home domain by highlighting the multi-resident home, the emotional intrusiveness of home healthcare technologies and the diversity that comes with providing care, unique to every household.

Research on attitudes to assistive technology (AT) has shown both the positive and negative impact of these technologies on quality of life. Building on this research, we examine the sociocultural and technological frustrations with hearing loss (HL) technologies that motivate personal approaches to solving these issues. Drawing on meet-up observations and contextual interview data, we detail participants' experiences of and attitudes towards hearing AT that influences hacking hearing loss. Hearing AT is misunderstood as a solution to the impairment, influencing one-to-one interactions, cultural norms, and systematic frustrations. Participants' exasperation with the slow development of top-down solutions has led some members to design and develop their own personalised solutions. Beyond capturing a segment of the growing DIY health and wellbeing phenomenon, our findings extend beyond implications for design to present recommendations for the hearing loss industry, policy makers, and importantly, for researchers engaging with grassroots DIY health movements.

Baby wearable technologies are becoming increasingly popular, particularly in early infancy. However, little research has been conducted to investigate how baby wearable technologies are adopted and used in parenting. This paper presents a two-week in-depth situated study with six mothers in their homes consisting of contextual entry and exit interviews, video recordings of "out-of-box" experiences, and a diary study. Using interpretative phenomenological analysis, participants' use and expectations of the baby wearable technology were examined. Use of the device directly impacted upon parents' knowledge production and anxiety, and influenced the perceived physicality and social factors of parenting. We frame these findings around sociological norms of the vulnerable child and responsible mother, as well as the notion of "lived informatics", where individuals' interaction with the technology influenced the perception, use and impact of the baby wearable on everyday parenting practices and familial relationships.

People are increasingly involved in the self-management of their own health, including chronic conditions. With technology advances, the choice of self-management practices, tools, and technologies has never been greater. The studies reported here investigated the information seeking practices of two different chronic health populations in their quest to manage their health conditions. Migraine and diabetes patients and clinicians in the UK and the US were interviewed about their information needs and practices, and representative online communities were explored to inform a qualitative study. We found that people with either chronic condition require personally relevant information and use a broad and varied set of practices and tools to make sense of their specific symptoms, triggers, and treatments. Participants sought out different types of information from varied sources about themselves, their medical condition, and their peers' experiences of the same chronic condition. People with diabetes and migraine expended great effort to validate their personal experiences of their condition and determine whether these experiences were 'normal'. Based on these findings, we discuss the need for future personal health technologies that support people in engaging in meaningful and personalised data collection, information seeking, and information sharing with peers in flexible ways that enable them to better understand their own condition.

Adults with Type 1 Diabetes have choices regarding the technology they use to self-manage their chronic condition. They can use glucose meters, insulin pumps, smartphone apps, and other technologies to support their everyday care. However, little is known about how their social lives might influence what they adopt or how they use technologies. A multi-method study was conducted to examine contextual factors that influence their technology use. While individual differences play a large role in everyday use, social factors were also found to influence use. For example, people can hide their devices in uncertain social situations or show them off to achieve a purpose. We frame these social behaviours using Goffman's theatre metaphor of onstage and offstage behaviour, and discuss how this kind of analysis can inform the design of future mobile medical devices for self-management of chronic conditions.

The use of wearable technology will become significantly more prevalent in the coming years, with major companies releasing devices such as the Samsung Gear Fit. With sensors, such as pedometers and heart rate monitors, embedded in these devices it is possible to use them for fitness purposes. However, little is known about how wearable adopters actually use wearable and existing technologies during exercise. In an exploratory situated study of technology use and non-use in the context of the gym, fitness informatics adopters showed varied practices related to distraction, appropriating technology into their routines, and information needs. We discuss this variance in relation to individual differences and the impact of the physical nature of the gym. Although further research might show other influencing factors such as the social context, we make a case for the use of situated studies to uncover tensions that lead to use and non-use of technology that arise in the different unfolding situations of using wearables in everyday life, including at the gym, which is a surprisingly complex context.

In this paper, we report on autoethnography as a method to access non-routine usage of mobile devices, such as during business trips, vacations, etc. Autoethnography, a self-study method with the researcher as participant, was employed for the evaluation of a wrist blood pressure monitor used by people with conditions such as hypertension. The findings from the study were surprising, especially with respect to the environmental and social impact on the use of the technology. Although the autoethnographic method can be disruptive for the researcher, it enables them to understand and empathize with the experiences mobile device users can face in difficult to access contexts. This method allows HCI researchers to better understand user experiences with mobile devices, including mobile medical technology, especially during non-routine times that can be difficult to study in-situ with traditional user studies.

The purpose of the study is to explore how chronically ill patients and their specialized care network have viewed their personal medical information privacy and how it has impacted their perspectives of sharing their records with their network of healthcare providers and secondary use organizations. Diabetes patients and specialized diabetes medical care providers in Eastern England were interviewed about their sharing of medical information and their privacy concerns to inform a descriptive qualitative and exploratory thematic analysis. From the interview data, we see that diabetes patients shift their perceived privacy concerns and needs throughout their lifetime due to persistence of health data, changes in health, technology advances, and experience with technology that affect one's consent decisions. From these findings, we begin to take a translational research approach in critically examining current privacy enhancing technologies for secondary use consent management and motivate the further exploration of both temporally-sensitive privacy perspectives and new options in consent management that support shifting privacy concerns over one's lifetime.