In recent years, there are a small but increasing number of personal informatics studies conducted in family settings. Most of these studies were conducted between adult parents and minor children. However, it is unclear how introducing fitness tracking into an intergenerational family influences individual exercise behaviors and family interactions. I address this gap through a mixed-method study based on the usage of WeRun, a fitness data sharing plugin embedded in the pervasive social networking app WeChat, with eight intergenerational families. This study finds that family tracking motivated participants to engage in physical exercise and family interaction. Nevertheless, family members were concern about potential privacy and independence issues. They also worried about the potential health issues resulting from becoming motivated to exercise beyond an appropriate level. This study demonstrates the unique challenges when designing to support fitness tracking for intergenerational families. This study advances the understanding of the influence of family tracking on different generations.

I present an observational study conducted to understand the phenomenon of information delivery to patients from healthcare providers in an Emergency Department (ED). My observations reveal different phases of a patient's ED care process, which I term as “milestones”. I report the composition of these care milestones in terms of information given to patients and the care team members who deliver information. Analysis of contextualized information delivery events across these milestones revealed three factors affecting information delivery and patients’ perception of information delivery. These factors are: temporalities in a patient's care process, invisibility of ED work to patients and a patient’s expectation and health literacy. My study shows how these factors affect information availability, and the time and content of information delivered to patients. The findings reflect on when and what information is appropriate to be delivered to patients, and how to design patient-centric technologies for information delivery to be appropriate with regards to the time, content and format of information delivery.

As societies across the globe grow progressively older, it is important to find ways to leverage technology to benefit seniors by assisting them to care for their health. Self-tracking is a strategy that can be used for health management and augmented by using technology such as smartphones and wearable devices.

Although most seniors use self-tracking for health, they most commonly rely on either paper or their own memories when tracking health data. Because their adoption of self-tracking technology is very low, seniors miss any benefits that might be gained from using self-tracking technology, such as self-knowledge, encouragement, or reduced burden. Overcoming this issue requires designing tools that appeal to seniors and meet their specific needs.

Although past research has found multiple barriers for seniors’ use of self-tracking technology, such as lower accuracy when counting steps due to gait or walking speed, there is still much we do not understand about how to create self-tracking technology that better meets their needs. My research investigates self-tracking for health among older adults, with the goal of understanding their existing tracking practices, their perspectives towards self-tracking technology, and their needs as potential users. In this dissertation I discuss three kinds of health-related self-tracking among seniors: wellness, self-management of chronic conditions, and recovery from a major health event.

Through a quantitative survey data reanalysis, I investigate the relationships of age and health status with tracking habits to understand the influence of each of these factors on self-tracking practices. Based on empirical evidence, I also describe seniors’ existing use of and perspectives towards self-tracking for health and the barriers for adoption of self-tracking technology among seniors.

Lastly, I investigate the role of self-tracked medical recovery data among stroke survivors and healthcare providers by describing their existing use of the data, the barriers limiting further use, and participants’ perspectives on potentially useful insights. Building upon these projects’ findings, I discuss barriers for senior use of self-tracking technologies, what unmet needs they exhibit, and promising directions for the design of effective self-tracking technology for seniors’ wellness, self-management, and recovery.

The U.S. healthcare system is known to be complex and fragmented. It presents as a black box to consumers as they often encounter a variety of challenges in obtaining the healthcare services they desire. To obtain a single service, patients often need to coordinate with multiple organizations, such as their employer, an insurance company, a physician practice, and a hospital. Such complexity and fragmentation manifests in isolation between patients, caregivers, organizations, and institutions. Yet little research has been done to understand how patients navigate the black box healthcare system. My dissertation research concerns the practices of parents of young children who navigated the multi-institutional healthcare system on behalf of their children in the United States. Through a narrative interview study of 32 parents from diverse racial, educational, and geographical backgrounds, I document how my participants as organizational outsiders navigated a complex system composed of diverse organizations and gain navigational competence. Building upon the empirical evidence, I conceptualize navigation practices and competence, and demonstrate multiple aspects of navigation practices. I further explore navigation practice in a concrete scenario that is choosing a provider, highlighting several factors that participants considered while making decisions. Lastly, I explore one specific type of navigation practice: the ongoing work that individual healthcare consumers engage in to make the fragmented healthcare infrastructure work for them, as a form of infrastructuring work. Building upon these findings, I discuss how navigation practice mediates the interaction between individual healthcare consumers and the “black box” healthcare system, and how design could better such interaction and help them obtain desired healthcare service.

This qualitative study is a result of conducting 6 month long observations and interviews of older patients in the senior health center at the University of California, Irvine medical center. The study revealed three areas within which challenges for older adults were encountered. These areas include 1) Information work management 2) Resource utilization and 3) Caregiver facilitation. The challenges within 1) Information work management include a) Lack of information work organization strategy, b) Caregiver responsibility co-ordination, c) Patient aggregated data exchange limitations, d) Comprehension challenges of specialized information, e) Patient medical history organization and retrieval limitations, f) Health care agenda planning barriers g) Lack of comprehensive analysis of healthcare outcomes. The challenges within 2) Resource utilization include a) Emotional barriers to resource use b) Lack of direction during resource use c) Lack of resource support for vital sign tracking and reporting. The challenges within 1) Caregiver facilitation include a) Privacy and access challenges and b) Task co-ordination. These challenges encountered are demonstrated during the “timelines of healthcare preparation” of before, during and after a medical visit.

These challenges present potential technology development and design opportunities for health informatics researchers and healthcare designers. In this work, challenges encountered and opportunities for design have been discussed by considering the three phases of 1) pre-visit information preparation, 2) facilitation of information exchange during the medical visit and 3) assistance during task execution after the visit.

No IT system is perfect at the time of its deployment. Users gradually adapt to the technology through everyday use. This is especially true for IT systems that are situated in complex environments, such as the healthcare domain. In a typical medical environment, information is constantly changing, and patient care tasks often require close collaboration among multiple providers and care teams. These challenges escalate the difficulties of designing effective health IT systems. They also makes users’ technological adaptation behaviors a particularly important research area as adaptation behaviors directly inform the (re)design of such systems. This dissertation investigates users’ adaptation behaviors and the subsequent redesign practice in an in-depth ethnographic study of an implementation of a hospital-wide Electronic Health Records (EHR) system.

I conducted two case studies in an Emergency Department (ED) affiliated with a large teaching hospital. The first study evaluates ways in which healthcare providers engaged in the adaptation process after a large-scale health IT system deployment; the second study examines the ways in which patients engaged in adaptive behaviors in this sociotechnical environment to leverage information breakdowns and ensure their quality of care. Qualitative and ethnographic formative research methods were used to examine both the providers and the patients’ information practices. The results of these studies indicate detailed adaptation processes. They shed light on how a newly deployed health IT system alters clinical work practices; how individual clinicians and a healthcare organization respond to a new system through technological and organizational adaptations; and how patients engage in various adaptive behaviors to achieve quality of care when information and technologies are not available and/or do not meet their needs.

Based on the study’s findings, I argue that the adaptation practices from these two different stakeholders are active end-user driven design practices, with significantly common characteristics. My study further reveals that these adaptation practices comprise two types of adaptive goals – one addressing immediate breakdowns and the other addressing healthcare specific needs – both of which are undervalued, yet crucial parts of healthcare organizations. This study provides broader design implications for evaluating and designing a sociotechnical information system in highly-regulated, complex, and information-critical contexts, focusing on the role of HCI researchers and designers.

The uptake of self-tracking technologies made it possible for health consumers to gather and interact with a variety of types of personal data. However, individuals often encounter difficulties in understanding and using their tracked health data. In my dissertation, I explore the data work individuals perform when self-tracking for health and the challenges of interpreting and using personal health data within their daily routines, interpersonal and institutional interactions, and life goals. I investigate these issues through the context of fertility, which is a data intensive, sensitive, and complex case of self-tracking that has recently drawn significant attention in the consumer health technology market. To examine this challenging context, in this dissertation I adopt a holistic approach comprising three studies to address multiple perspectives: (i) through the analysis of an online health community I explain the individual challenges of fertility data work and individuals’ emotional engagement with their health data, (ii) through a mobile app review study I investigate how individuals’ data work is mediated, supported, and shaped by technology, and (iii) through an interview study with individuals facing fertility challenges and healthcare professionals specializing in infertility care I discuss how fertility data influence and are influenced by broader ecologies of care. These studies show how individuals’ data work for health is strongly entangled with their emotional experiences and technology often falls short of adequately supporting people’s diverse data needs and changing life goals. They also highlight how individuals’ data and self-tracking activities do not exist in isolation and their data work is shaped by interpersonal, organizational, and societal influences. Drawing from these findings, I discuss specific characteristics of the data work performed by individuals that should be considered when researching and designing technologies to support individual data work for health, explaining how societal pressures are transmitted to the individual through technology and drawing implications for design and for practices beyond the individual.