Matthew Dawson

Abstract • UK healthcare system under pressure due to ageing population, underfunding, and COVID-19.

• Research found smart health monitoring technology could mitigate these issues by increasing older adults’ ability to manage their health and sustain independent living and improving quality of life.

• Requirements were specified using knowledge gained from a literature review, existing technology review, and focus group with older adults.

• A proof-of-concept prototype heart monitoring system was designed and developed using an iterative user-centred approach including older adults at each stage.

• Older adults approved the implementation, praising its ease of use and ability to help them manage their health.

• Findings from this development process can be used in future projects to ensure their suitability for older adults.

Literature Review Key Findings • Heart data visualisation should be as simplified as possible, with colourbased methods mentioned by older adults.

• However, the underlying raw data should remain alongside or inside the visualisation as older adults tended to become confused by visualisations that were too abstract.

• Older adults were found to be hesitant to adopt health monitoring technology due to fears it would reduce their social contact, so it would be important for the system to improve that or at least not diminish it.

• Using emojis to visualise health data was found to assign negative emotions to their health data and were also found to misinterpret emojis more frequently than younger users, so should be avoided.

Key Requirements derived from Existing Technology Review • Push notifications to the user’s device to notify them of an abnormal heart rate.

• Display previous heart values so users could study them for any patterns that might emerge.

• Filtering previous heart values by date to make the large dataset more manageable and accessible.

• Export the previous heart data to CSV file format, so users could send it to a doctor for analysis, or keep it as a backup external to the system in case they ever delete their account.

Key Requirements derived from Older Adult Focus Groups • Mobile-first design due to participants using mobile devices much more than computers and laptops but scoring similar levels of competency when taking mobile/computer proficiency questionnaires.

• Noise-based heart notifications to grab user’s attention.

• Adding text labels underneath any icons to improve accessibility.

Iterative Design Process Optimal Heart Visualisation Focus Group: • Older adults chose the traffic-light heart icon as their optimal visualization method, matching the literature review recommendations for a simplified colour-based option with underlying data preserved.

Low and High-Fidelity Paper Prototypes: • Older adults suggested changing the inputs for upper and lower heart thresholds to be an average BPM instead.

• They also recommended extending the call for help countdown to 15 seconds to give enough time to cancel during a false alarm.

• They additionally suggested making the heart icon in the navigation bar functionally identical to the main heart visualisation to allow monitoring on any page of the application.

Implementation • ReactJS and CSS were used to create a client system with user interface.

• The client hooks into a PHP API server-side system to send and retrieve live heart data and user/device details.

• The API’s data access layer modifies and searches an SQLite database, which stores the received heart data, user account details, and device information.

• Use Case, Class, Sequence, and Entity Relationship Diagrams were used as blueprints to create the working product and points of reference to ensure the system fulfilled its requirements and remained suitable for older adults.

Testing • Older adults completed all scenario tasks.

• They appreciated the audio notifications to catch their attention and whitespace between buttons to avoid mis-presses.

• They found the system easy to use and had the potential to improve their ability to manage their health.

• Older adults scored the system above average when completing System Usability Scale and User Experience Questionnaires.

• This suggests that the product accomplished its goal of helping older adults manage their health more effectively, while being appropriate and suitable for older adults to encourage adoption.

Conclusion • Health monitoring technology can improve older adults ability to manage their health.

• Increasing its adoption has the potential to improve living standards and lowers strain on health services.

• A user-centred approach is very beneficial when designing for older adults, eliciting first-hand opinions and perspectives that are essential to ensure systems can be easily adopted by older adults.

• A simple colour-based visualization preserving the underlying data to avoid abstraction is the optimal health visualization for older adults, and future systems and studies should take this into account to maximize the chances of adoption.