Theory Meets Practice: Using Critical Analysis to Design Inclusive and Accessible Technologies

Mikki Kressbach, Loyola Marymount University

Kyla Yein, UCLA

This assignment asks students to use critical media analysis to propose designs for inclusive and accessible technologies.

Overview

Kressbach and Yein

This assignment is co-authored by the instructor (Kressbach) and a student (Yein) who was enrolled in the course. We collaborated to provide a systematic review of the assignment design and student learning experience. As you move through this article, you will see authorship attributed to the two different perspectives, oscillating between the goals of the instructor and the impact on students. We hope this format illustrates how a collaborative, open dialogue between parties can be used to develop innovative assignments and create impactful student learning opportunities.

Context

Kressbach

Through a focus on close textual analysis, the field of Media Studies has emphasized critical approaches to technology. By examining the design, production, and policies of a device, platform, or media texts, scholars often critique the way technologies communicate particular ideologies or exclude populations or bodies. While this work provides essential insight into the way technologies and power operate, criticism often serves as the endpoint—and this extends to the way students engage with technologies in a critical studies classroom. In other words, students can often identify the problem with the technology, but rarely can they imagine or suggest a solution. This article describes an assignment that asks students to put their critical analysis into action by proposing creative revisions aimed at developing more inclusive and ethical technologies.

The assignment was part of a course titled, “Science, Medicine and Digital Media,” housed in the Department of Film, Television, and Media Studies at Loyola Marymount University. The course was designed to satisfy the university’s interdisciplinary core curriculum requirement by combining work from Film and Media Studies with Critical Health Studies. There were 18 students enrolled in the course, primarily from disciplines with the School of Film and Television.

Assignment

Kressbach

Students in my Fall 2022 course created written and visual proposals for revisions to existing wellness technologies.

The primary goals of the assignment were to:

• Identify how inequity was present in the design and marketing of the devices.
• Encourage students to see how the class's close analysis and critical readings could be applied to create real-world solutions.

Preparation

Prior to this final assignment, students were assigned one of four wellness technologies: UprightGo Posture Trainer, Lookee Sleep Tracker, Muse Meditation Headband, and Headspace Meditation App. Working together with those assigned the same technology, they completed a group presentation focused on the critical analysis of the design, marketing, privacy policies, user experience, and existing scientific research on the device or health concern (see Appendix A for the full description). The group project focused on familiar modes of critical analysis: close reading and literature reviews. The task was primarily to point out existing problems or concerns with the company’s marketing, policies, and design that could later be used in the final proposal assignment.

Structure

The final assignment was broken down into four sections in an effort to model Kristin Ostherr’s praxis-based approach to research in the digital health humanities. Step one: critically analyze the technology’s policies, practices, and design; step two: use experimental design and collaboration to address concerns found in step one (Ostherr 2019). To simulate this process, students moved step-by-step from analysis to research-based, experimental design:

• Provide an overview of the technology and identify existing concerns or issues.
• Offer a visual or written proposal for revisions. This can be anything from a visual mock-up for a website, advertisement, or interface to descriptions of the campaign, or copy for a website or advertisement. It should provide enough visual/written information that your audience can imagine the proposal as they read.
• Provide a justification for why the proposed revisions would address the stated issues. The justification should be supported by outside peer-reviewed sources with proper MLA/Chicago citations.
• End with a brief discussion of problems that may remain despite your revisions and/or further research or studies that should be conducted to study the effects of your revisions.

Assignments were evaluated based on the following criteria:

• Does the student clearly identify existing problems? Are the problems supported by evidence in the form of close analysis and/or citations?
• Does the student draw logical connections between their creative proposal and their justification? Does the student articulate why their revisions address specific issues raised in the first section? Is the work supported by research?

Ultimately, I was less concerned with whether a student’s work was novel or innovative. Grading was largely based on the reasoning and evidence used to support their creative choices. My evaluation stressed the importance of presenting a well-supported argument that showed the connections between design, equity, and inclusion.

Student reflection

Yein

As a student, especially one with previous research experience in the digital humanities, I felt that integrating research into a visual solution in response to this framing helped me shape a critical lens that utilizes both theory and practice. I was able to do so by following the order of the assignment, where I had to analyze the problems of the device, which allowed me to critically examine the design and marketing of the technology and apply my findings by creating a solution. I found this to be useful in response to the inequitable components of the wellness device because I could go beyond simply citing class readings and materials and form a creative solution to the problem in focus.

By approaching the technology from a critical perspective, I was able to interact with my assigned device, the LOOKEE Sleep Monitor, in a more mindful, comprehensive way, where I could notice components of the technology that could be a point of inequity. I considered multiple factors, such as the design of the ring, the product’s website and marketing, and the app design—all of which raised concerns and served as possible points for my solution (see Appendix E). Initially, I chose to do a visual proposal because I felt that it could represent and support my solutions in a more detailed manner. I struggled with this part of the assignment because I found that it was difficult for me to visually represent a missing element of the wellness device, as it was easier for me to identify problems rather than solve them by creating. However, after I considered the issues of my assigned device and why I identified each issue as such, I was able to re-imagine what the improved technology could look like. I was able to pinpoint that I wanted to focus on regarding the lack of emphasis on phenomenology regarding symptoms and chose to create a diary system that would be displayed alongside the collected numerical data (see Appendix E). This would serve to provide a better insight into how the user felt in relation to their symptoms while encouraging mindfulness.

Creating a solution grounded in critical theory helped me become more aware of how to interact with wellness devices outside the classroom. Now, when observing and interacting with wellness technologies, I can identify their inequities relating to who may be excluded from its interface, design, and marketing, shaping how I can approach engaging with such devices.

Learning outcomes

Yein

For the assignment, the students were able to choose between the two options: a written proposal or a visual proposal. Ten students completed written proposals and eight completed visual proposals. I found that the type of proposal produced a difference in the focus of the work. The written proposals identified existing problems and provided strong critiques of the design and marketing, whereas the visual proposals tended to focus on clear and creative solutions to existing problems. For example, Student A (see Appendix C), tasked with the LOOKEE Sleep Monitor, provided a written analysis of the marketing and target demographic on the company’s website. Through the analysis of the website’s design, they effectively argued that the device failed to address the intended audience. I found that writing provided a way for this student to be thorough in identifying and explaining the device’s problems and its marketing, especially noting the exclusion of the target audience in favor of “healthy” and young individuals. In contrast, the visual proposals often had strong and clear solutions but spent less time discussing existing problems with the wellness device. For example, Student B (see Appendix D), who was assigned the UprightGo Posture Tracker, proposed that the device should be lightweight and unnoticeable for users who have sensory issues. This student’s proposal was straightforward to understand, given the visual nature, and addressed the learning objective to “create real-world solutions.”

In both cases, student work was somewhat uneven, either focusing on identifying problems or providing solutions. For the written proposals, the emphasis on critique often created stronger justifications for existing problems, but the creative revisions could be more persuasively argued by drawing on visuals. This difference could be attributed to the need to provide a more thorough explanation of the proposal due to the lack of visuals to explain the solution. In the case of visual proposals, the images could be strengthened through a more thorough written account of the reasoning behind their design choices.

Future directions

Kressbach and Yein

In order to address the uneven results described above, we suggest a more structured approach to the assignment design that asks students to draw direct comparisons between the stated problems and creative solutions. For example, a revision of the assignment could ask students to create a slide deck using Google Slides, Powerpoint, Keynote, or Canva:

• Identify two or three problems with an existing technology. Each problem should be separated out onto its own slide(s) and supported by evidence in the form of close analysis or outside research.
• Provide a corresponding slide that visualizes your creative solution to each stated problem. Your slide can use images, texts, graphs, etc, but should flag the specific components that address your identified problem. For example, use arrows and captions to remind your audience of the problem, and direct their attention to your revision or solution.
• Create a justification slide for each problem/solution that clearly articulates how your solutions address an existing inequity or bias. The justification should be well-argued and supported by outside peer-reviewed sources with proper MLA/Chicago citations. You should include clear statements on why your proposal addresses an existing bias or inequity.
• Finally, offer a single slide that includes a brief discussion of problems that may remain despite your revisions and/or further research or studies that should be conducted to study the effects of your revisions.

This design asks students to be more direct about the relationship between critical analysis and creative solutions. By structuring the assignment in the form of a step-by-step presentation that requires visuals, students will have to provide a clear initial assessment of a problem followed by logical justifications for their proposed revisions. While faculty could simply require students to submit a slide deck as their final assignment, in-class presentations followed by Q&A could be a useful addition to reveal possible problems or test the reasoning and logic behind their arguments.

While this assignment has focused on a very specific set of wellness technologies, the project design could be used to analyze and reimagine a range of other technologies, products, or problems. Any course that focuses on critical analysis of technology, marketing, or products could take a similar approach. For example, a course on social media may ask students to analyze the way a platform may encourage bias or hate speech and then propose solutions that could combat an existing design component. Faculty working on disability and accessibility may also find this assignment useful to critique existing built environments, technologies, and objects and reimagine a space or platform for differently abled bodies and minds. Finally, faculty working in fields related to the production of media and technology could find the assignment a useful way to incorporate critical analysis into their courses. For example, a screenwriting student could analyze a script draft, identify possible problems with existing characters or storylines, and then propose a solution to make their script more diverse and inclusive. Or a student working in the health and human sciences could analyze an existing medical technology, platform, or protocol and propose solutions to improve patient care and access.

References

Appendix A

Wellness Technologies Project Instructions

Students will be assigned a wellness technology and complete the following projects:

• Group Presentation
• Revising Wellness Technology Proposal

Learning Outcomes

To develop their media literacy, students will:

• Examine a wellness technology from a variety of critical perspectives
• Scrutinize cited scientific sources and forms of expertise
• Analyze the design and marketing of a wellness technology
• Critique the existing design, data privacy policies, and marketing of a wellness technology
• Propose revisions to the design and marketing to create more ethical and inclusive wellness technologies

Group Presentation

Each group of five students is tasked with examining and analyzing the following components of their assigned wellness technology. While groups may divide the labor however they would like, I recommend tasking each member with a specific component.

• Company and Marketing
• Data Privacy Policy
• Scientific Studies and Experts Cited by the Company
• Interface Design
• User Experience

Requirements

• 20 to 30-minute presentation
• Powerpoint/Keynote/Google Slides
• Incorporate at least two concepts/readings discussed in the course
• Cover all of the components listed above
• Demonstrate that every member of the group contributed to the presentation
• Use MLA or Chicago Citations

Analysis
Marketing/Company

Examining the company website and advertisements, ask the following questions:

• Who is the target market? How do you know? Who is left out of this market?
• How is the product advertised? What slogans/buzz words/iconography does the company use to sell their product?
• What fantasy of health/wellness is the company selling?
• Who is behind the company? What training and background do the designers/CEO have?

Data Privacy Policy

Read through the data privacy policy and ask the following questions:

• Who appears to be in control of the data? Are users able to control the type of data tracked and shared by the company?
• Can users control how their information is viewed by the company or other users?
• Is data being sold to third parties? Do users have the ability to prevent their data from being sold?
• Can users extract their data?

Scientific Studies and Experts Cited by the Company

Look at the sections of the website dedicated to the science, research, and FAQs where experts and studies are cited and ask the following questions:

• What health or wellness concern(s) does the technology address? Why might it be useful for a technology to address these concerns?
• What scientific studies are cited?
• Look up the citations and ask: Where and when was the study completed? How big was the study? Do the results match the statistics/claims presented on the company website?
• Who are the experts cited by the company? What is their background/training?
• What health and wellness benefits are advertised by the company? Are there citations to support such claims?

Interface Design

Examine the device and corresponding app and ask the following questions:

• What is the device quantifying and/or tracking? How is that information presented? Are there data visualizations, graphics, etc. used to present the data?
• Does the app set specific goals? How are those goals visualized/tracked? Can they be adjusted? Do they increase over time? Are there awards/badges/competitions? What are they for? How can users earn them?
• If the device is providing processed data (e.g. a “score”), does it provide information on how those numbers are calculated?
• How would you describe the aesthetics of the app interface? What color schemes/iconography/animations appear? How would you describe the language/rhetoric used by the app?

User Experience

Use reviews, website testimonials, message boards/forums, and your own experience using the device to ask the following questions:

• How do users describe their experience with the device? Does the device “produce” the health and wellness benefits marketed by the company? Are there differences between accounts provided by the company and those found in reviews/message boards/forums?
• What problems do users highlight? What problems did you encounter while using the device?
• How would you describe your experience using the device? Practice phenomenological description as a way to examine how the device and app made you feel about your body and wellbeing.

As a group…

design a presentation that provides an overview of the technology, highlighting both the possible benefits and issues/concerns/problems that you notice along the way. Analysis should be informed and supported by readings and concepts covered in the class.

Appendix B

Revising Wellness Technology Proposal

Using the analysis from the group presentation, propose a revised marketing campaign, website homepage, or interface design. The proposal should focus on how to make the technology more ethical or inclusive.

Requirements

Proposals should be composed of the following parts:

• A short overview of the existing technology, identifying the key issues the proposal will address (300–400 words)
• A visual or written proposal for revisions. This can be anything from a visual mock-up for a website, advertisement, or interface to descriptions of the campaign or copy for a website or advertisement. It should provide enough visual/written information that your audience can imagine the proposal as they read.
• A justification for why the proposed revisions would address the stated issues. The justification should be supported by outside sources with proper MLA/Chicago citations. At least two sources should be new, i.e., not a reading assigned in the class. (600–800 words)
• A brief discussion of problems that may remain despite your revisions and/or further research or studies that may remain despite your revisions and/or further research or studies that should be conducted to study the effects of your revisions. (100–200 words)

Appendix C

Sample Student Proposal A

“LOOKEE Ring Sleep Monitor Revision Proposal”

The LOOKEE Ring Sleep Monitor is a wearable device that works to track and provide ways to improve sleep quality for patients with sleep apnea. The device works as a sleep tracker in the form of a ring that you simply wear throughout the night and it measures and records the user’s heart rate and oxygen levels as they sleep. Through a paired app, the user is able to view sleep reports and analysis on ways to improve sleep. The device is targeted towards those who experience sleep apnea, which is a sleeping disorder caused by the obstruction of airways resulting in frequent halts in breathing during sleep. For patients with sleep apnea, the LOOKEE Ring can identify low levels of oxygen paired with high heart rate and will emit a vibration to signal the user to shift their sleeping position. This serves to be a more comfortable and less intrusive form of sleep apnea therapy. The device can also be used in tandem with CPAP machine therapy as a backup in case of CPAP failure.

The marketing of the product however, presents some contradictions in alignment with the target market the product looks to serve. The issue is that while the LOOKEE Sleep Ring looks to serve patients with sleep apnea, who tend to be in middle-age to older adults, much of the advertising in commercials or on the company website does not reflect this audience. The depiction of young healthy individuals are shown as the users of the device. A more inclusive form of marketing through target audience representation and advertising appeals for an older audience are suggested within this proposal. Additionally, another issue found with the LOOKEE Ring Sleep Monitor is the lack of scientific studies as a basis of validation for the product. In correlation with marketing, a suggested plan to provide users with opportunities to improve the technology and contribute to the furthering of sleep research is discussed as a solution to the lack of scientific data shown in the marketing.

Revision Proposal Justifications

The following sections (Marketing, Education and Experts and Scientific Research) pair with the corresponding sections outlined in the separately attached slides- visual presentation of proposed revisions to the LOOKEE Ring Sleep Monitor.

Marketing

The main issue with the marketing of the LOOKEE Ring Sleep Monitor is that it was not focused on the target audience: sleep apnea patients- most commonly people in the middle age to older aged adult range. The proposed revisions regarding the marketing aspect of this product are centered around this issue. Solutions such as highlighting sleep apnea benefits, representing the more common user population through models in advertising, and providing simplified and easy to find information to appeal to this older demographic will be discussed.

In order to create a marketing scheme that is more focused on their target audience, the first suggested revision is to provide a product overview that directly states who the target audience is. In clearly stating that this is a product that will benefit sleep apnea patients, those seeking alternative therapies can be directed to LOOKEE for viable options in their search for relief. Additionally, by incorporating more inclusive promotional photos such as those of different body size and depicting older patients and those with partners is an appeal to a wider range of users. For the older demographic, it can evoke a sense of intimidation when products are advertised with models who are young and healthy, especially when approaching new health technology. By showcasing to the target audience that users are people that look like them, it can instead allow them to visualize themselves successfully using this product. Including photos of users with their partners as well can show how sleep quality can be improved for both the user and those who may also be affected by their partner’s sleep disorder.

Another suggestion that would improve marketing for the target audience would be the use of rhetoric that specifically appeals to the middle age to older adult demographic. In the ‘How Does it Work’ slide, very simple and straightforward language is used to show the ease of product use, making the introduction of new technology into everyday routine seem less intimidating. By showcasing the simple nature of the LOOKEE ring, it can show distinctions from other sleep apnea therapies (such as CPAP machine) that would appeal to target users. Additionally, throughout the proposal the conscious use of this rhetoric is continued throughout, key words such as ‘comfort’, ‘restful’, and ‘undisruptive’ are used to capture those seeking sleep quality improvement.

Education and Experts

In partnership with the marketing section, is proposing the addition of an education section to the company website. Through personal experience with the LOOKEE company website, I believe there is a need for an education section to allow users to directly have access to the resources needed to make an informed decision on this type of technology. The education and experts section proposed here serves also as a marketing tool to show users that LOOKEE will provide them with the tools necessary to improve their sleep quality, all in one place.

By educating users on sleep apnea and the different types of this sleep disorder, they can be more informed on what device would work best for their situation. While the LOOKEE website does have a section with blog posts describing sleep disorders and sleep apnea, it is hidden within the site and takes some digging to find. By having its own tab or page on the website, users have direct access to this information and are less likely to be directed to other products when searching for more information on external sites. Additionally, in comparing the LOOKEE Ring with the traditional CPAP machine therapy prescribed to sleep apnea patients, you can again see the appeal of the comfort, ease and more agreeable nature of the product.

Another main issue that was found with the LOOKEE marketing, was the lack of expert testimonials, the main person highlighted was a dentist that had recommended the LOOKEE Ring Sleep Monitor to patients experiencing sleep apnea. However, this was one expert testimonial that was not well expounded. In proposing the addition of another section of the website to be titled ‘Ask an Expert’ the same principle is built upon by providing users all the resources they need to be confident and successful in the use of the product. By doing more research, 3 professionals were included in the ‘Ask an Expert’ page. The first being the same dentist (Scott E. West, DDS) who provided testimonials originally, as it is beneficial for users to have access to someone with personal interest and experience recommending the product. In doing research on sleep apnea therapy, I came across Sarah Hornsby, a sleep apnea therapist & dental hygienist, who runs a blog online and provides counseling and programs for those interested in sleep therapy (Hornsby). Contacting this professional or accessing her blog would allow users to find a community in those also seeking improved sleep quality. The third professional included in the proposal is Dr. Roy Artal, a sleep medicine physician who is the director of the Tower of Sleep Medicine at Cedars-Sinai (“Our Doctors”). By providing contact to this professional, users can seek professional medical advice regarding their sleep disorders and the potential health effects/benefits of using the sleep tracker.

Scientific Research

In an effort to include more scientific research and create more studies to confirm the validity of the LOOKEE Ring Sleep Monitor technology, a suggestion to add the opportunity for users to join research studies is proposed. The goal of creating an opportunity for users to participate in studies is to directly find ways to improve the quality of sleep technology. This in turn benefits the overall progression of sleep technology and sleep disorder research. This is marketed as an appeal to user’s as well, that by simply joining a study they become a part of a community that is working towards improving and developing this realm of research.

According to the author of a sleep tracker research study, “To improve the performance of such devices, technology manufacturers should develop algorithms in collaboration with clinical or research enterprises” (Gruwez et al. 2019). Gruwez et al. found their sleep tracker device of choice (Bodymedia SenseWear Pro Armband (SWA)) to be successful in measuring users time in bed and tracking of light sleep. This was one of the studies that collected data on a wearable device comparable to the LOOKEE Ring Sleep Monitor and the main conclusion was that despite their results, there needs to be more research and developed studies done in this realm. In an article reviewing the possible benefits of new sleep apnea technology, the author states, “sleep research requires new technologies to investigate underlying mechanisms in the regulation of sleep in order to better understand the pathophysiology of sleep disorders... Telemedicine allows recording with little subject interference under normal and experimental life conditions”(Penzel et al. 2018). They confirm the need for more studies to be done on these technologies in order to confirm their effectiveness and continue improving sleep technology.

Future Directions

Moving forward from this proposal, should these revisions be employed, it is important to follow up on the effectiveness of these changes. Checking in on statistics of users and seeing if the target audience demographic (sleep apnea patients of middle-older age adults) increased in attraction the device would be a big step for the marketing issues discussed here. However, it should be acknowledged that shifting the marketing strategy to the target demographic could potentially result in decreased attraction by users who may just be using the product for tracking purposes or sleep quality improvement without having a sleep disorder. However, this risk is the nature of marketing and is why studying the statistics of consumers can show if making the proposed shift would be effective or not.

Additionally, proposing the implementation of users being able to join optional research studies would have to be assessed as well. A big factor would be the number of participants joining as it is necessary to have a sufficient sample population in order to make credible conclusions from any research study. By assessing the number of participants, it can be determined if the marketing strategy for attracting participants was effective or not as well.

References

Gruwez A, Bruyneel A-V, Bruyneel M (2019) The validity of two commercially-available sleep trackers and actigraphy for assessment of sleep parameters in obstructive sleep apnea patients. PLoS ONE 14(1): e0210569. https://doi. org/10.1371/journal.pone.0210569 Hornsby, Sarah. “Sleep Apnea Exercises.” Sleep Apnea Therapist, 22 Mar. 2019, http://sleepapneatherapist.com/.

“Our Doctors.” Tower Sleep Medicine, 2 Dec. 2021, https://www.towersleepmedicine.com/about/our-doctors/.

Penzel T, Schöbel C and Fietze I. New technology to assess sleep apnea: wearables, smartphones, and accessories [version 1; peer review: 2 approved]. F1000Research 2018, 7(F1000 Faculty Rev):413 (https://doi.org/10.12688/f1000research.13010.1)

Appendix D

Sample Student Proposal B

“Wellness Technology Proposal: Upright Posture Device”

Overview

The Upright Posture device is a small, lightweight tool to track and improve posture. The device is connected to an app that tracks and records user data. The setup is simple, and the data is pretty straightforward, mostly outlining users’ progress over time and comparing the time spent sitting up in good posture versus slouched. It is attached to the top center area of the back with a sticky pad that can be switched out every couple of uses to maintain grip. The other option is to wear the device in a necklace style which some users prefer. Some users experienced issues with the sticker maintaining a grip on the back due to bodily movement, skin type, and dryness vs. moisture on the skin. Considering the problems we ran into with the use of the device, various factors could be improved to make Upright more inclusive/ethical.

My main concern is how someone with sensory issues might use this device. Many people with sensory issues can feel uncomfortable wearing anything that impedes their movement. While there is the option of the necklace, that also could cause problems based on the object's heaviness and how that would weigh on someone’s neck. There are a variety of conditions that make wearing extra devices uncomfortable and unrealistic for certain individuals. These could include ADHD, ADD, Autism Spectrum Disorder, Sensory Processing Disorder, OCD, Anxiety, and other conditions. While sensory disorders can come in various types depending on the person, it is safe to say that many people could be prevented from using this device based on the disruption it can cause to the physical body. There are also potential implications with the link between mental and physical. Perhaps the biggest issue is the buzzing sensation that alerts users of their slouch. The app can adjust this, but even the lowest setting can be pretty jarring. This is especially true for conditions like OCD which can cause people with this disorder to perform repetitive motions, which could make this device difficult to use for these individuals.

Revisions

The previous model- The Upright posture device interface, is potentially intrusive and bothersome for individuals with sensory struggles. As is shown in the promotional images for the Upright Posture device, the size and buzzing features of the device are noticeable to the user.

Proposed Revision

While I do not necessarily have the scientific background to know if this is a possible solution, I think making the device much thinner and lightweight would make it not only more accessible but also much more popular. If the device were virtually undetectable to the user, there would likely be little to no sensory issues that could arise for users. It would raise the cost due to the complex technology and expensive materials likely required, but it could open the product up in terms of the market.

Justification

By making the device's physical experience more accessible, the Upright Posture device will be more ethical and accessible. Not only that, but the simple interface will make it much more comfortable, which will entice more users into using it. According to Sensory Issues For Adults With Autism Spectrum Disorder by Diarmuid Heffernan, “there are a number of sensory modalities which are used by humans to interpret their environment” (Heffernan 29). The connection between sense and perception is undeniably a considerable portion of how people navigate everyday interactions. The reading also explains that in addition to the five senses, the vestibular and proprioceptive systems work together to regulate the intake and output of sensory action. It continues to describe how touch works using a complex set of receptors to feel sensations of pressure, heat, cold, and texture. The author describes a term known as discriminative touch, which allows one to differentiate feelings (Heffernan 32). These are located on more exposed areas such as the face and fingers and thus are not as much of a concern on areas like the back. However, there are receptors for touch, including temperature and pain, all over the body, meaning that these could still be felt on the upper back where the posture device is typically located.

Heffernan explains how the proprioceptive system works to allow one to know where their limbs are without looking to locate them. In addition, the vestibular system works in the body to monitor and input the motions of the head. Heffernan states that “While there is a large degree of variance across other studies, it is clear that sensory issues are a feature in the lives of a significant proportion of people with autism, and increasing empirical evidence shows us that this is the case (e.g., Baranek 2002; Ben-Sasson et al. 2009; Crane, Goddard and Pring 2009)” (Heffernan 41). The author explains the various relationships to sense perception that people with ASD can experience. The text describes that both hyper and hyposensitivity (extreme overreaction or underreaction to different scenes, including temperatures, textures, pain, etc.) are factors of ASD. The reading does an excellent job of pointing out that issues with sense do not belong exclusively to neurodiverse folks. They state, “The sensory differences each individual experiences may also be influenced by many of the factors that play a part in shaping every human being such as schooling, parenting, sibling relationships, friendships, isolation, socio-economic and geographical factors amongst others (Heffernan 44).

Another source explores how garments and other sensory stimuli impact children with Autism Spectrum Disorder. The author states that “Particularly, hyperresponsiveness to sensory stimuli has been found to have a negative effect on participation in social and community occupations, likely due to these settings being unpredictable and not easily controllable by parents [10]” (Mische Lawson 2). This study focuses on clothing and its effects on the stimulus issues for children with ASD. While this is somewhat different from the proposed revisions, it is one of the only studies that studies something somewhat similar to the proposed revisions. The author states that “Other types of sensory garments, including seamless options, may also improve children and family outcomes, though evidence on their use is minimally available. Kabel et al. [22] suggest autistic children who demonstrate stress from sensory-agitators (i.e., sensory stimuli they find aversive) may benefit from sensory-sensitive clothing that consider seams and materials [22]” (Mische Lawson 2). Thus, the author supports claims that sensory-friendly clothing benefits those with ASD. Thus, it could likely be concluded (with the help of future testing) that the Upright Posture device would be more ethical/accessible if it had a more sensory-friendly design.

Remaining Problems

As mentioned before, the biggest problems that remain for these proposed revisions are making the revisions possible. The cost to thin out the device would entail paying for thinner wires which are more expensive than the current model’s. In addition to the interface of the device being redesigned, the phone app will likely have to be updated to be compatible with the changes. So, that should be kept in mind as part of the total revisions. Other problems will inevitably remain with the device as the first interactions of such technologies are often not completely inclusive. Most of this exclusion is not intentional, as it is tough to know what adjustments will need to be made until a variety of people test the product. That said, I would be curious how a device like this would work on someone who uses a wheelchair or has another physical disability. It should be a factor in consideration for future improvements to the device.

Works Cited

Diarmuid Heffernan. Sensory Issues for Adults with Autism Spectrum Disorder. Jessica Kingsley

Publishers, 2016. EBSCOhost, https://search-ebscohost-com.electra.lmu.edu/login.aspx?direct=true&db=nlebk&AN=11 60112&site=eds-live&scope=\site.

Mische Lawson, Lisa, et al. “Exploring Effects of Sensory Garments on Participation of Children on the Autism Spectrum: A Pretest-Posttest Repeated Measure Design.” Occupational Therapy International, June 2022, pp. 1–8. EBSCOhost, https://doi-org.electra.lmu.edu/10.1155/2022/3540271.

Appendix E

Sample Student Proposal C

“Revising the LOOKEE Ring Sleep Monitor”

Overview of the LOOKEE Ring Sleep Monitor

Aimed to alleviate sleep apnea symptoms, the LOOKEE Ring Sleep Monitor continuously tracks blood oxygen levels and heart rate throughout the night and ensures the user is sleeping on their side. The sleep tracker consists of a thick, rubber ring and a screen attached to the ring that displays the user’s vitals. These vitals are displayed through the corresponding app, where one can access any biometric data collected with the sleep monitor. Although the device’s interface and the data it collects appears to be beneficial for improving one’s sleep quality and overall health, quantifying sleep leads to the dissolution of the boundary between rest and “work” due to the nature of tracking the body and its functions. In other words, self-tracking using the LOOKEE Ring Sleep monitor “datafies” sleep, changing this personal experience to be centered around constantly “working” to improve one’s health. This amplifies the pressure to “improve” oneself through quantified data, specifically aiming to fit a health standard to “fix” sleep apnea.

Furthermore, quantification perpetuates the “one-size-fits-all” framing of health, where users must interpret their collected sleep pattern data and determine if it is of the “norm.” This health standard excludes those who have other health issues which can affect their sleep vitals, such as heart rate, thereby rendering the “definition” of health moot. The sleep monitor, seemingly a beneficial way for individuals to handle sleep apnea, emphasizes quantification of the body as a “solution,” which fabricates the need to improve one’s health by “working” to adjust personal data to fit health standards.

Revision Proposal

In light of these issues, I propose a “revised” version of the LOOKEE Ring Sleep Monitor, one that will still assist in alleviating sleep apnea symptoms and be used with a CPAP machine, but will not integrate the biometric framing of health through quantification.

Shown in the diagram above, the screen component of the LOOKEE tracker should be removed, and the ring should remain. The ring is still made of rubber and can be adjustable to a range of sizes (not pictured) like the “original” ring. The vibrating function also remains when the user is sleeping on their side, but the ring no longer continuously tracks blood oxygen levels and heart rate during sleep.

In association with the revised ring, there should be a LOOKEE health app that users have access to. It does not display how many times the ring vibrated, the blood oxygen levels, or the heart rates, but it prompts users to log how they slept - specifically their activities and observations before and after their sleep. Pictured above, users can access the app and keep track of how restless or restful their sleep was and supplement this information by describing their emotions and any feelings or symptoms their body was experiencing. This information can be organized by date, choosing between a list and calendar, so the user and/or their doctor can easily view any sleep patterns.

Justifications for proposal

Since the tracking function is no longer part of the device, hence the removal of the screen component, the revised ring does not center around any quantification of the body. I chose to remove the quantification feature because the biometric framing of health it promotes self-surveillance, where “self-tracking involves the data subjects themselves being confronted with their own personal information and, in many cases, being invited to engage with this information in some manner as part of optimizing and improving their lives” (Lupton 2016). For the LOOKEE device specifically, self-surveillance occurs when the individual tracks their sleep vitals such as blood oxygen level and heart rate and is undergoing continuous data collection from their own body.

Furthermore, quantification from the LOOKEE sleep tracker imposes health standards on the user which makes it difficult to analyze the collected data. Those who utilize self-tracking devices like the LOOKEE tracker often do so to attempt to understand their health problems, such as sleep apnea. They use the tracker to collect data about their sleep patterns and analyze the numerical results to do so and health standards are used to compare the user’s data to the “norm.” Doing so supports harmful rhetoric centering on what it means to be “healthy” because those who have vitals differing from the standard may interpret them as “unhealthy,” creating a “need” for further treatment and search for a solution. As a result, “[s]elf-monitoring and self-care for health and medical purposes become part of the burden of treatment ...” (Lupton, The Digitally Engaged Patient 263), making the quantification feature more harmful than helpful for many users. With just the absence of self-tracking vitals and continuing the use of the vibration feature, users can still be reminded to sleep on their side to help mitigate the effects of sleep apnea without imposing a health standard on themselves through self-surveillance.

Additionally, I chose to add a diary function because it prompts the user to reflect on the state of the body and how sleep apnea can affect the bodily experience. By writing down what they were doing and how they were feeling, the user can shape their understanding of how the lived body is “bound up with, and directed toward, an experienced world” (Leder 123), where such reflection allows the individual to mind any surrounding elements. Instead of tracking one’s vitals every night and visualizing such data, a written log of how the user is feeling, what activities they did, and any related emotions can be much more personal, thereby easier, to analyze - rather than a dataset consisting of medical terminology and numerical standards. Integrating this aspect can reform the boundary between “work” and sleep as there would be no active tracking throughout the night, while the user can still record personal, written logs before and after sleeping. Utilizing phenomenology underscores the connection between the lived body and the mind, which is crucial for understanding health problems, specifically sleep apnea, because “[e]ngineering a stable sense of self entails ... looking beyond the body...” (Smith and Vonthethoff 13). This combats the harmful biometric framing of health that self-tracking devices adhere to, while resisting objectifying bodily processes as phenomenology is invoked instead of quantification. Linking a LOOKEE health app to encourage users to practice phenomenology when logging their daily insights promotes a well-rounded, holistic approach to living with sleep apnea.

Potential problem with the revision

Despite the proposed revisions, there are still issues surrounding the device. Because the LOOKEE ring is designed to help with sleep apnea and other related health problems, those who seek to use it must purchase the ring to utilize its features that supplement the CPAP machine. This, in turn, adheres to the neoliberal notion that individuals must buy the LOOKEE to understand their health problems and even potentially solve them, allowing them to gain an advantage over those who do not own one. Owning the device is an advantage because of its features, such as the diary function of the LOOKEE app that lets users share their daily logs with their healthcare provider. This lets both the user and healthcare provider assess and gather a deeper insight on the health problem. However, the society in which we live and function in is inherently neoliberal as it is associated with Western capitalism, so this issue would be rooted in societal incompetence, making it a complex situation to “fix.”

References

Leder, Drew. 1992. “A Tale of Two Bodies: The Cartesian Corpse and the Lived Body.” The Body in Medical Thought and Practice. Dodrecht, NL: Springer. https://link.springer.com/chapter/10.1007/978–94–015–7924–7_2.

Lupton, Deborah. 2013. “The Digitally Engaged Patient: Self-Monitoring and Self-Care in the Digital Health Era.” Social Theory & Health 11: 256–270. https://link.springer.com/article/10.1057/sth.2013.10.

Lupton, Deborah. 2016. “The Diverse Domains of Quantified Selves: Self-Tracking Modes and Dataveillance.” Economy and Society 45, no. 1: 101–122. https://www.tandfonline.com/doi/full/10.1080/03085147.2016.1143726.

Smith, Gavin J. D., and Ben Vonthethoff. “Health by Numbers? Exploring the Practice and Experience of Datafied Health.” Health Sociology Review, vol. 26, no. 1, Jan. 2017, pp. 6–21. https://doi.org/10.1080/14461242.2016.1196600.

Acknowledgments and Permissions

The devices used in this project were generously funded by the Loyola Marymount University Academic Technology Grant. The sample student work included in Appendixes C–E has been anonymized and students have consented to share their sample work. This project was IRB-approved through Loyola Marymount University (LMU IRB 2022 Su 04‐R). All students were given the choice to opt out of using the devices if they were uncomfortable with the company’s data privacy policies.

This entry is licensed under a Creative Commons Attribution-NonCommercial-ShareAlike 4.0 International license.