British Heart Foundation
Health Promotion Research Group
SENSECAM 2013 UCSD

Influencing health-related behaviour with
wea...
Main diseases are lifestyle related...

Highlight main diseases are lifestyle
related

The Lancet 2013, 380(9859), pp. 209...
Commercial devices: lots of hype but no RCTs

Lack of physical activity RCTs on these devices:
• most advanced remote tech...
Why wearable cameras?
• They identify health behaviours:
• - Physical Activity & Active travel (Doherty 2013, Kelly 2011/1...
Wearable cameras measuring health behaviours
Increasing awareness
- Self-monitoring made easy vs. diary
- Ability to recor...
Wearable cameras measuring health behaviours
“…even when the behavioural responses are the same
between conditions, activa...
Wearable cameras measuring health behaviours
Increasing motivation
- Images can support productive counseling
during thera...
Wearable cameras measuring health behaviours
Reviewing Progress
- Engaging images of target behaviour fed back
to users vi...
What are the ethical issues of using first person
image capture to observe and influence health
behaviours?
What are the ethical issues of using first person
image capture to observe and influence health
behaviours?
HEALTH WARNING...
What are the ethical issues of using first person
image capture to observe and influence health
behaviours?
HEALTH WARNING...
What are the ethical issues of using first person
image capture to observe and influence health
behaviours?

Collecting th...
Collecting and analysing the
images
Using the images as part of an
intervention
• Accepted treatment…?
• Information of benefit to participant…?
• Non-malificence?
• Behaviour change or empowerment…?
Ethics of behaviour change
• Obtrusiveness - the degree to which an intervention
intrudes into an individual's life
• Tran...
Wearable camera interventions
•
•
•
•
•

Loss of confidentiality
Harming confidence or motivation
Blaming others
Inappropr...
“The law may not permit privacy”
Allen et al., (2011)
“The law may not permit privacy”
Allen et al., (2011)

What would you do?
• Text and drive
Final thoughts
“Technologies often evolve
faster than legal and ethical
systems are able to respond”
O’Hara et al., 2009
Influencing health-related behaviour with wearable cameras: strategies & ethical considerations
Influencing health-related behaviour with wearable cameras: strategies & ethical considerations
Influencing health-related behaviour with wearable cameras: strategies & ethical considerations
Influencing health-related behaviour with wearable cameras: strategies & ethical considerations
Influencing health-related behaviour with wearable cameras: strategies & ethical considerations
Influencing health-related behaviour with wearable cameras: strategies & ethical considerations
Influencing health-related behaviour with wearable cameras: strategies & ethical considerations
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Influencing health-related behaviour with wearable cameras: strategies & ethical considerations

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Aiden Doherty and Paul Kelly
Nuffield Department of Population Health
University of Oxford

BACKGROUND: The growing global burden of noncommunicable diseases makes it important to monitor and influence a range of health-related behaviours such as diet and physical activity Wearable cameras appear to record and reveal many of these behaviours in more accessible ways. However, having determined opportunities for improvement, most health-related interventions fail to result in lasting changes.

AIM: To assess the use of wearable cameras as part of a behaviour change strategy and consider ethical implications of their use.

METHODS: We examine relevant principles from behavioural science theory and consider the way images enhance or change the processes which underpin behaviour change. We propose ways for researchers to instigate the use of and engagement with these images to lead to more effective and long-lasting behaviour change interventions. We also consider the ethical implications of using digital life-logging technologies in these ways. We discuss the potential harms and benefits of such approaches for both the wearer and those they meet.

DISCUSSION: Future behaviour change strategies based on self-monitoring could consider the use of wearable cameras. It is important that such work considers the ethical implications of this research and adheres to accepted guidelines and principles.

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Influencing health-related behaviour with wearable cameras: strategies & ethical considerations

  1. 1. British Heart Foundation Health Promotion Research Group SENSECAM 2013 UCSD Influencing health-related behaviour with wearable cameras: strategies & ethical considerations Aiden Doherty and Paul Kelly Nuffield Department of Population Health November 2013
  2. 2. Main diseases are lifestyle related... Highlight main diseases are lifestyle related The Lancet 2013, 380(9859), pp. 2095-2128
  3. 3. Commercial devices: lots of hype but no RCTs Lack of physical activity RCTs on these devices: • most advanced remote technology is the telephone! • pre & post measures based on (unreliable) selfreport Gurrin, FnTIR 2013 (in submission) Foster C, Hillsdon M; Cochrane Db of Systematic Reviews 2013, Issue 9.
  4. 4. Why wearable cameras? • They identify health behaviours: • - Physical Activity & Active travel (Doherty 2013, Kelly 2011/12) • - Sedentary behaviour (Kerr 2013) • - Nutrition (O’Loughlin 2013, Gemming 2013) • - Alcohol / smoking ?? • They are fun & engaging to review: • - Georgina Browne (Memory 2011, 19(7):713–22) • - Finnoula Murphy (Memory 2011, 19(7):768-777) • - Peggy St Jacques (Memory 2011, 19(7):723-32) Doherty 2013, Am J Prev Med 43(5), 320 – 323
  5. 5. Wearable cameras measuring health behaviours Increasing awareness - Self-monitoring made easy vs. diary - Ability to record a greater range of behaviours than existing commercial devices Increasing fun & enjoyment - More frequent review of behaviour - Supports autobiographical memory which may include emotional association Michie; Health Psychol 2009; 28(6); 690-701 Ryan & Deci; Self-Determination Theory
  6. 6. Wearable cameras measuring health behaviours “…even when the behavioural responses are the same between conditions, activation differences remain (see Figure 1b)…” “…SenseCam images may provide such a powerful cue that reviewing them is sufficient to reinforce consolidation of the episode into a retrievable long-term memory store. By contrast, a written diary does not provide sufficiently powerful cues to overcome the hippocampal deficit…” Berry; J Nrol Nsurg Psy 2009;80:1202–1205
  7. 7. Wearable cameras measuring health behaviours Increasing motivation - Images can support productive counseling during therapeutic sessions (Burke 2011) - Potential to induce positive mood change through emotional association (Murphy 2011) Increasing confidence - Ability to repeatedly highlight episodes of behavioural successes until goals are achieved Michie; Health Psychol 2009; 28(6); 690-701 Ryan & Deci; Self-Determination Theory
  8. 8. Wearable cameras measuring health behaviours Reviewing Progress - Engaging images of target behaviour fed back to users via - e.g. Vicon Autographer image review via smartphones Michie; Health Psychol 2009; 28(6); 690-701 Ryan & Deci; Self-Determination Theory
  9. 9. What are the ethical issues of using first person image capture to observe and influence health behaviours?
  10. 10. What are the ethical issues of using first person image capture to observe and influence health behaviours? HEALTH WARNING 1 – Enthusiastic amateurs
  11. 11. What are the ethical issues of using first person image capture to observe and influence health behaviours? HEALTH WARNING 1 – Enthusiastic amateurs HEALTH WARNING 2 – probably can’t cover everything in 10 mins
  12. 12. What are the ethical issues of using first person image capture to observe and influence health behaviours? Collecting the images Using the images
  13. 13. Collecting and analysing the images
  14. 14. Using the images as part of an intervention
  15. 15. • Accepted treatment…? • Information of benefit to participant…? • Non-malificence? • Behaviour change or empowerment…?
  16. 16. Ethics of behaviour change • Obtrusiveness - the degree to which an intervention intrudes into an individual's life • Transparency - the extent to which an intervention is covert (UK Parliamentary Committee on Science and Technology, 2011)
  17. 17. Wearable camera interventions • • • • • Loss of confidentiality Harming confidence or motivation Blaming others Inappropriate sharing Equitable access challenges
  18. 18. “The law may not permit privacy” Allen et al., (2011)
  19. 19. “The law may not permit privacy” Allen et al., (2011) What would you do?
  20. 20. • Text and drive
  21. 21. Final thoughts “Technologies often evolve faster than legal and ethical systems are able to respond” O’Hara et al., 2009
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