Consider the Happisburgh hand axe: a chunk of flint, fashioned into a tool, discovered in 2000 in Norfolk, England. Just by the design of the groves knapped into each side, you intuitively know where the fingers fit around it and where the thumb is supposed to go: a natural, comfortable fit. It has no user guide, no instructions for use, no CE mark, no icons. You just hold it in your hand and you know how it works. With the sharp end, it cuts, it scrapes, it chops, it butchers. With the blunt end, you can use it as a hammer.

Intuitive use, yet it was not even developed for us: not for our hands, not for our fingers. It was made between 600 and 800,000 years ago by homo antecessor, the probable common ancestor of both the Neanderthals and the homo sapiens. The axe that was discovered must have survived at least five ice ages.

The simplicity of this low-tech tool aptly illustrates what modern technology should be to the user: simple and accessible, undemanding and untaxing.

I find it hard to be excited about technology. I am not an enthusiast. This is a strange admission for someone engaged in usability testing of technologies, but it is true. I always see technology through the eyes of those testing (laypeople), rather those commissioning the test (the client). What interests me is how a piece of technology is used. What difficulties do people encounter when they first use it? What do they find easy? How intuitive is it? To what extent are the icons interpreted correctly? Are the instructions clear and easy to follow? Does it do what it is designed to do?

I like seeing the reactions in test participants when they find a difficulty and manage to resolve it themselves, the tiny eureka moments. I enjoy and appreciate the participants’ earnest feedback about what improvements they would like to see implemented. In my experience, people genuinely want to help create a better experience for other users. Maybe the ergonomic finish of flint axes also followed a process of testing and tweaking: collaborative design by iteration.

Outside the usability lab, I love researching how the general public use technology, particularly with regard to health and in ways that are unexpected. Take, for example, the developing world. In 2019, over 50% of the global population is now online, with 726 million new people coming online just since 2016, with a high proportion of this number coming from China, India and Africa. It is expected that the remaining 50% of humanity will be online within the next 5 years.

The standard line routinely put forward by big tech firms and aid organisations are that online technology will be used for self-improvement, giving instant access to education and health information where it may otherwise be unavailable. In reality, entertainment and socialising are really the main motivations for getting online. Education and health information comes second. With social networking, in particular, comes a number of unexpected developments: people becoming politically polarised and locked into their own communities of opinion (USA, UK, India), the spread of hate and an enabler of genocide (Myanmar), not to mention the propagation of dangerously false health beliefs (everywhere). Far from a gateway to self-improvement, these are unintended, unexpected and negative consequences of technology. Perhaps this should not be surprising. I’m sure that, in addition to chopping and cutting, the homo antecessor also used their axes to crack a skull or two. They were cannibals, after all.

However, there are plenty of examples of positive aspects of being online with regard to health-seeking behaviours. In Myanmar, many young women are bypassing local cultural taboos, using smartphones to understand more about menstrual cycles and their bodies. They can also use an app to ask online doctors questions in full anonymity, without fear of shame. In China, research has shown that 90% of what new mothers have learned about breastfeeding has been from online sources. This has been the fruit of personal initiatives to seek out this information. The main drive of this was that printed information about breastfeeding in China, although widely available, varies in quality. These are often translated from foreign sources whose illustrations show Western female bodies, rather than Chinese ones and, therefore, culturally inappropriate.

Health-seeking behaviour online is an interesting area of study. For many, health online is a navigational nightmare, not in terms of actually finding information, but in discerning the best quality health advice from the rest of the noise. In China, where there has been huge growth in smartphone-based telemedicine services since 2011, investigations have shown that a large proportion of the online doctors operating these services have fake credentials.

Websites offering quack advice have had a presence in higher-income countries for some time. Take Spain and Portugal, for instance, where there has been a growth in alternative health information resources. These include sites that recommend people with cancer to forego medical procedures and treatments, like chemotherapy or surgery, and try miracle cures instead, such as bee venom therapy and green tea. These may well have some benefits, but they surely cannot be advocated as the sole means of treatment. If you are seeking information about cancer and you have low health literacy, limited experience online and no medical background, how are you supposed to judge the quality of information that you find? And many people do have a low level of health literacy.

This meander of an article is to illustrate the breadth of issues that will be covered in the Technology in Health area of this blog. We draw on our experiences in usability testing, medical informatics and other areas to explore:

How people seek health information online and whether there are any cultural differences in how this happens
How beliefs about health are expressed online
Best practice in usability testing of health technologies
New developments in health technology, forever looking for a latter-day Happisburgh hand-axe.

Each article will be techie-lite and will focus on use and acceptability by ordinary people.

By Mark Gibson, Health Communication specialist

13th September 2019, United Kingdom

References:

Oliver N, A History of Ancient Britain, Orion Publishing Group, London, 2011
Mudie C, The Happisburgh Hand Axe – the oldest hand axe in north-west Europe, Museum Crush, 20th October 2017 [retrieved from https://museumcrush.org/the-happisburgh-hand-axe-the-oldest-hand-axe-in-north-west-europe/]
You ain’t seen nothing yet, The Economist, June 8th 2019
Speak no evil, The Economist, June 23rd 2018
Zhije Yang, Magic hands at a price, China Report, June 2018
Yiwei Z, Ying X, Ailing Market, China Report, Vol. no. 67, December 2018
Os Perigos do Dr. Google, Visão, 15th November 2018
Gamez LA, El timo de la medicina alternativa, Muy Interesante, October 2018

Prehistoric hand axes and technology in health