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Society may harm your health

To collect data for the article Rationale Behind Socially Influencing Design Choices for Health Behavior Change, I moved to Spain to work in a company as interaction designer with their design team. In the article, I left unmentioned one observation that was carved into my mind and that I think about until today. The impact of society on technological design I came across through this design team’s experiences.

The article presents – among others – four categories influencing the design of applications targeting behaviour change for patients. The following figure shows them in homocentric circles. The practitioners usually started thinking from the outer circle to the inner.

Homocentric cycles showing user/patient in the centre in the social environment of the condition, which is in the social environment cycle, which is in the medical condition cycle
  • The medical condition influences the design mainly in terms of accessibility, for example the design is adjusted to accommodate for the patient’s shaky hands, blurry vision, or any type of severe fatigue.

  • The social environment influences the design based on preconceptions and beliefs of the cultural context. For example, if one experiences lung cancer, people may think that he was smoking heavily, whereas one who experiences breast cancer is perceived as a female hero, a survivor. However, a person experiencing lung cancer may have been smoke free all their life, and the breast cancer patient may be a male.

  • The social environment of the conditions is how the patients act within the condition, for example female breast cancer patients are active, we see the pink ribbons even in the supermarket, but how often we see dark or light blue ribbons for colon and prostate cancer respectively?

  • Finally, it is the patient who is seen as a user of the technology.

The social part covers 50% of the design team's rationale.

Society can harm your health visualised in a cellphone screen as it would have been on a cigarette package

First, I worked on a breast cancer app for female patients. The design of the app had social features that connected the patients with each other, that was from the start of the design process. There was no question IF the social features would be implemented but HOW. Then I worked with the design of a prostate cancer app. There the social features were left to be discussed at the end as the least necessary, even though the literature and a psycho-oncologist (in an interview with the senior designer) supported the opposite. Why so much resistance then?

The senior designer gave me the answer that the patients chose to keep their condition for themselves and close family because of the social preconceptions and beliefs. The cancer treatment may lead to side effects on the patient’s sexual life. Even though this is also a reality for females experiencing breast cancer, in the case of males experiencing prostate cancer, it was an issue. Apparently, in Spain (and based on my experience this is the same in Greece and in general Mediterranean countries) the sexual life of a male is related to masculinity. Therefore, if one openly says that he has prostate cancer, it is like he admits that he is less of a man, as prostate cancer implies sexual dysfunction. This condemns the patients to isolation, and they may experience feelings of deviance and loneliness because they may be the only prostate cancer patients they know.

Chronic conditions and especially cancer influence negatively patients’ mental health, and mental health issues in people with chronic conditions are often left overlooked. Contact with other patients is important for feeling that they are in a group, fight loneliness and take courage. However, an app designed to have social features may scare the users away from using the app. On the other hand, if we leave the social features out of the app, we (designers) become accomplices in a way to the decline of the users’ mental health.

Our society, how each one of us think and act, can harm people. Our preconceptions are carved into our minds and often we act on them without even noticing. How can we, as designers and as individuals, be aware of our actions, reflect on them and make a shift to a healthier, more empathetic, and more understanding society?


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