More than a third of Americans now use health-care apps and wearable devices, tracking everything from walking steps, heart rates, caloric intake and running speeds to daily moods, hourly medications and monthly fertility cycles. For users with disabilities — the blind person who cannot read a touchscreen at the gym or the older person whose slow gait is inaccurately recorded on a wearable device — the tracking tools can be a frustrating mismatch. 

This year’s UW iSchool Distinguished Alumni Award honoree, Eun Kyoung Choe (Ph.D. ’14), is taking on these challenges, helping to design intelligent health-tracking tools that are more relevant and accessible to marginalized populations. “If we keep creating technology that is not accessible to all, we are only going to widen the health disparity gap that already exists in this country,” says Choe, a tenured associate professor at the University of Maryland’s College of Information.

The dean of her college, professor Keith Ansel Marzullo, recruited Choe in 2017 and has watched her continue to break ground in the rapidly evolving health-care tracking field since. “She has become one of the intellectual leaders in this important and dynamic area,” Marzullo says. 

Choe, whose work has been funded by such distinguished institutions as the National Institutes of Health, the National Science Foundation and Microsoft Research, has a long list of best paper awards and honors, including a prestigious NSF CAREER award. She received a bachelor’s degree in industrial design at the Korea Advanced Institute of Science and Technology and a master’s degree in information management and systems from the University of California, Berkeley, before coming to the UW iSchool in 2008, drawn by what she describes as the UW’s “small but very vibrant and active” human-computer interaction community.

It was her own unhealthy sleep habits during that time that triggered her interest in tracking. As a graduate student at the UW iSchool, her sleep schedule fluctuated significantly and she often went to bed at irregular times. “I thought it was normal for work to drive my sleep,” she says. “Then I learned about sleep hygiene and realized having a consistent sleep schedule is really important for your overall health.”

She knew she had to change her sleep behavior, but how? “To do it, I had to understand my current sleep behavior, which required tracking. And that’s how all these things got started.”

Her early interest in tracking led to her research on the Quantified Self movement, which supports a global community of networked trackers whose motto is “Self Knowledge Through Numbers.” The devoted Q-Selfers Choe studied tracked such things as work productivity, body fat, panic attacks, blood glucose, smoking, snoring, allergic reactions, movie consumption, even the daily occurrence of puns. One took self-portraits every day for a year to check daily mood; another studied whether eating butter could increase cognition. Some built their own devices for tracking.

“I think being able to count and measure things is a very powerful skill that humans have,” Choe says. “My research goes beyond the counting to connecting the numbers, making meaning out of the data so that people can reflect on themselves and set personally meaningful health goals.”

The Q-Selfers she studied tended to be young, healthy, tech-savvy and able to afford pricey new tracking gear. “I didn’t question any of that at first,” Choe says. “But over time I realized that those who could benefit most from health tracking are often the less healthy individuals and they have tended be marginalized from mainstream technologies.” 

Lessons from Q-Selfers

Choe decided to turn her research lens on these under-researched and typically overlooked populations. One focus was older adults, whose slower movements are significantly underreported in common tracking tools. “Older adults might walk slowly, or they may have different gait characteristics, or use a cane, a wheelchair, a walker. Existing technology is not attuned to track these different types of walking,” she says.

Nor does existing technology accurately reflect the lifestyle activities many older people care about, research showed. In a weeklong survey of adults ages 61-90, Choe and her team used a speech-based, easy-to-use Android Wear app they created called MyMove that allowed participants to verbally report their daily activities. Participants registered meaningful activities as not only biking, walking and swimming, but gardening, housework, hobbies, going up and down stairs, even moving room to room, making a cup of tea or pushing a grocery cart at the store.

“Older adults care a lot about health-related activities but the nuance of the activities is different than what you expect from younger people. While a young person may consider the more steps the better, an older person’s goal might be to not overexert themselves,” says Choe, whose team is using findings to fine-tune new tools for older adults.

Choe incorporates a wide range of voices in creating more equitable health-tracking designs. “I love her co-design and ability-based design approach, where technology is genuinely co-created and inspired by, with, and for the people who need it,” says Choe’s research partner JooYoung Seo, assistant professor at the University of Illinois Urbana-Champaign’s School of Information Sciences. Choe initially brought Seo on board to collaborate on research in health-tracking challenges faced by blind and low-vision populations.

Choe describes existing health and fitness technologies as heavily “vision-centric.” She points to treadmills that display workout data on a screen that visually impaired users can’t read. Some participants in her study worked around that problem by using external technologies compatible with a screen reader that reads text aloud. Such workarounds can be valuable for designers and researchers, says Choe. “The workarounds give us a lot of insight into what is not working in the existing technology and we can learn what might be possible by piecing out their approach.”

Stroke victims are another focus of her study. They often experience upper-limb muscle weakness or paralysis on one side of their bodies and need intense physical therapy to retain function in the affected arm. In collaboration with researchers at UMass Amherst, Harvard University and the manufacturing firm FormSense, she helped develop a finger-worn ring with sensors that monitors upper limb activity and gives users helpful feedback. 

She’s now looking at how best to optimize that feedback. “Some stroke victims may face difficulties with thinking, memory or perception, so it’s important to design representations of data that are accessible and understandable in a way that accommodates their abilities,” says Choe, who envisions a future where advanced health-tracking systems can be tailored to meet unique abilities and needs of individuals.

Student becomes a teacher

Choe came to the UW iSchool in 2008 as a self-described non-trained, naïve student and was transformed into a career researcher by her professors, including mentors Wanda Pratt, iSchool professor, and Julie A. Kientz, professor and chair of the UW’s Human-Centered Design and Engineering department. “She was my first Ph.D. student graduate and it has been thrilling to see how her career has flourished over the years,” says Kientz, who nominated Choe for this year’s Distinguished Alumni award. 

Choe still remembers the words Kientz told her as she wrapped up her iSchool graduate studies. “Julie said: ‘You’ve become an independent researcher, now go out and train other people.’”

That is exactly what Choe has done, sharing her knowledge and skills with new cohorts of researchers. The proudest moment of her career, she says, was the day her own first Ph.D. student graduated. The student’s name is Yuhan Luo and she is now an assistant professor in computer science at City University of Hong Kong. 

Working with Choe was one of the most valuable experiences in her life, says Luo. “She taught me how to conduct research with high standards of honesty, thoroughness and rigor, eventually helping me grow into an independent researcher. She also equipped me with the confidence to foster a supportive and rigorous research environment for my own students.”

One valuable lesson passed along from the iSchool has been fundamental in Choe’s teaching: the need for researchers to be open-minded and open to change. She was, and she ended up unexpectedly writing a dissertation on sleep-monitoring, something she’d never thought she would do.

“If graduate students come to a school and focus exclusively on one research idea, they may be missing out,” Choe says. “The students are getting important input from their classes and their professors and if they don’t change from that whole process, then what is the point? They are meant to be changed.”