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The infliction of COVID-19 worldwide has forewarned humanity of the insufficiency in the healthcare system, especially health care workers and health care resources. In a pandemic like this, countermeasures are necessary to elevate the healthcare system to the next level and in this paper, using speculative design as a key is the proposal to digitize healthcare services into an e-system, a mobile application, or a wearable health monitoring system that is capable of biomedical measurement that collects real-time health information from the user and provides a health monitoring service to improve users' daily lives and change their habits. This innovative systemizer project contributes to people's health, well-being, and the sustainable development of future medical services.
The overloading of the healthcare system caused by the unprogressive manner of the current system itself as well as the patients. It is humanity's desire to rush to any hospital immediately whenever they feel sick. However, without solid data, people would overload them entirely. Moreover, there are many steps before they could reach the doctor, such as making appointments that may require them to come back at another time, another day, or even several weeks later. On some occasions, the delay of treatment could risk humanity on the verge of spreading a pandemic, and as the awakened mind of health consciousness, especially after the COVID-19 pandemic, humanity is calling for better health quality and lifestyle management systems.
Born from the need of using technology and the need of digital transformation of medical services, this service consists of a wearable health monitoring device, a smartphone application while using Artificial Intelligence (AI) to collect and analyze the Big Data of the users, their symptoms, all in the form of data to make immediate reports before the pandemic and similar situations in the future. In recent years, mobile phone applications and wearable high-tech devices have contributed to present-day lifestyle. Goodyear (2019) cited that most of the health-related applications nowadays focused on one's wellness, diet, and exercise (Lupton, 2017). Additionally, from her previous work in 2017 and Wartella's article, Goodyear referred that those who are interested in healthcare applications are also interested in health-related wearable devices (Wartella et al 2016; Goodyear 2017). Hence, there is an inseparable link between a smartphone application and a smart health wearable device. This device uses different types of sensors to monitor the circulation of the wearer's body to detect heart rate, pulse, blood pressure, temperature, sleep hours, etc. while sending this data to either the application or to a cloud server where data can be stored and analyzed by AI technology before sending to any medical professional, medical institute or even family members (Figure 1). Following the IoT and Big Data methods, collected data will automatically convert to the medical data by providing two-way analysis for early feedback suggestions and sharing it with the hospital for emergency conditions. Besides, this device will come with healthcare daily suggestions and recommendations, answering the people's concerns while enhancing their everyday activities.
Figure 1. An overview of the whole service
This device assists users so that they can understand their body's needs and make preventions to symptoms that would happen before time. Still, some factors lead to today's problem, and among them, the aging population and the cost for older people's effective healthcare service are the rampant ones. The key point of this innovation is that patients can do health monitoring by themselves at home, but for the elderly, their acceptance attitude towards medical technology and the privacy concern are the key problems that need identifying within this paper. Therefore, in order to implement this concept idea, this paper uses the five core principles of service design, the Kano model, and digital transformation analysis as design tools to identify the important elements of the user. To discern user needs along with the healthcare quality service strategies, this paper provides scenarios and expects to give the quality enhancement of the wearable healthcare device industry. It can be expected more from this service as it will integrate well with the speculated idea and technology to provide a better environment of smart health concepts in the future.
This paper aims not only to propose personal health monitoring but also a service behind it. Using speculative design, this service explores the necessity of wearable health sensory devices and a smartphone application while designing innovative features to attract a certain target user such as the elderly while having an in-depth review of the role of design in the digital transformation of medical service.
According to Cho, "The healthcare function of the wearable device can be beneficial for efficient preventive/post management services in that the user's body information can be monitored, and communication with healthcare professionals is always possible" (Cho et al. 2019). Each year, the human population keeps growing more and more while the number of hospitals stays the same. Therefore, this device and the service it is offering is the supreme demand that will answer users' needs by including multiple features within the medical scope.
Cho, "health is influenced by genetic causes, social environment, environmental factors, behavioral patterns, and medical care" (Cho et al, 2019). In his research, he mentioned the importance of the healthcare system to maintain population health with low-cost conditions to tackle this issue earlier. Based on the concept, the wearable device also makes a significant opportunity to sustain the human necessity in new normal conditions. In addition, learning purposes revealed by Goodyear, digital health technology can potentially impact on human's health knowledge and create a new health behavior of the young generation (Goodyear et al. 2018)
However, there are challenges in designing this device. According to Li recent research about the acceptance model for the elderly, the need for elder health care and assistance has increased these years significantly. Although the elders are encouraged to use smart wearable device feature such as activity surveillance is causing distress to them, the complexity of usage and usefulness also affect their technology adoption (Li et al, 2019). In another research conducted by Dr.Petrovčič, his research was about the familiarity of the elderly with smartphones and apparently from his observation, the smartphone would not be a 'gateways to health information or e-health interventions for seniors,' but his result shows that seniors are interested in the care-assistive application (Petrovčič et al. 2019). Regarding the acceptance of the wearable healthcare device, in a recent study of Yu-huei, this research mentioned that accessibility to the social connection of the elderly is one of the reasons compared to teenagers who, most of the time, have a digital device at their fingertip. While the usage complexity can affect their interest in health-related products and the intention to use, group behavior is another factor that can stimulate their desire to own the device (Yu-huei et al, 2019). Therefore, having a group of teenagers to encourage and to promote the elderly the usage of healthcare devices is a preferable solution to prevent rejection.
On the other hand, keeping the functionality as simple as possible and the allowance of autonomous features in assisting the elder's usage can ensure their desire to adopt this device and service. For instance, the smart online doctor appointment service, Yu-huei, also discusses automatically contacting the hospital in case of emergency (Yu-huei et al. 2019). Nevertheless, based on Yang's study, today's community has been getting used to the online appointment system, and some patients would rather use it to investigate their favorable specialist than their family physicians (Yang et al. 2019). Even so, another benefit of owning wearable devices revealed by Jo is that wearable devices are tools that can change users' health behavior (Jo et al., 2019).
Design can play an important role in understanding the reason behind users' behavior toward the product and service. Different studies have been using service design, design principles, and speculative design to explore the requirement for a pervasive wearable healthcare system. Page integrated his users in a speculative collaborative approach to research the usability of a medical device (Page et al. 2018). In his article, he cited from Zhang that "Use error is the leading cause of medical device failure" and from Jones, "In extreme cases, these errors can lead to injury and death" (Zhang et al. 2003; Jones 2013). While Page uses co-creative to identify the usability of wearable healthcare devices (Page et al. 2018), Dugstad uses co-creative as an approach to thoroughly identify the risk and the potential of the digital transformation of long-term dementia patients' health observation (Dugstad et al. 2019) Hence, in this paper, using Human-centered design (HCD) as the foundation, this service concept analyzes the needs of the patients' interests in order to shift their daily life activity towards a pervasive healthcare system. Additionally, using the service design approach, together with its five core principles: user-centered, co-creative, sequencing, evidencing, and holistic, can escort the healthcare system to face the complex challenge of the digital era. Besides, the principles can also integrate the research in the healthcare-related topic to solve both technical problems or the user issues that will interrupt the whole research process. Ongoing with the speculative design, this paper forms the speculation to sketch a vision and insight into the direction where future technology would inspire further technology development for personal healthcare devices.
To analyze the detailed scenario following Ray Schleibs concept idea (Service Design Thinking – 5 Core Principles for Great Service Design | I Imagine Strategy, n.d.). This paper employs the five core principles of service design as distinguished by the categories of User-Centered, Co-creative, Sequencing, Evidence, and Holistic.
User-centered. From the users' perspective, this stage investigates the user requirement to deliver a well-defined way for the user so that they would be attracted to this device and service. During the COVID-19 pandemic time, the elders are the group that suffered the most, so this innovation is mainly focused on them. Hence, this service should benefit the elderly the most as a pervasive healthcare assistant. Additionally, this service targeted new normal era people who become more interested and more aware of their health, yet do not have sufficient time to manage it.
The reusable feature of the device makes it possible for the user to use medical services without becoming a disposable waste. The user is the center of the objective of medical services, but it is necessary to think about the environment, so this description is essential to be included.
The fact that one of the services offered is that the device is washable and waterproof, makes the user feel comfortable not having to worry too much about the medical device being damaged and at the same time, being able to keep up with hygienic care since it is one of the health goals. The flexible screen allows the user to easily obtain the information without too much concern that it is uncomfortable to use or that a rigid screen makes it difficult to read and is a distraction from carrying it on the body.
Detecting emotions is one of the critical points in terms of user-centered. Users with emotion control problems and users who have high blood pressure can meet their needs and manage their emotions. This feature guarantees that their care is at the center of design development, and therefore, satisfaction can be expected from the development of the same.
One of the factors to consider for the care of the user's well-being is the heating system of the device, with this it makes the inconveniences and the dissatisfactions are eliminated, or at least highly diminished. Another characteristic that fits perfectly with the objective centered on the user is the system of daily medical recommendations. This makes the user feel protected and cared for, with which the service offered guarantees loyalty and long permanence on the part of the consumer.
When the users obtain the medical information of any procedure that the service is offering, one of the aspects that can ensure that it will obtain through this device is that they can share it with their family and close friends. This helps the user feel confident in the product since their emotional and security needs are being met. The geolocation system, which offers patients the possibility of finding nearby hospitals and health centers when they need, is clearly a service thought and focused on the user, for their comfort and safety.
Co-creative. To maintain sustainable innovation, this step involves all the stakeholders in the design process of this research. In this research, users and medical professionals are the stakeholders and co-design partners. From their perspective, it is possible to view the business opportunity, the requirement, or the scopes to answer the medical need and determine the necessary process for both the device and service. Besides, with the professionals' help, it is possible to review the legal policy before further development of the wearable device. From the advantage of viewing from the stakeholders' perspective, the service becomes more useful for both users and the future market while the author can take a further step to understand the value and market direction of the service. If it is needed to develop a service that has one of the features that is reusable, it is necessary to form a team that ranges from designers, marketers, doctors, to engineers and biologists, since the product that is desired for the user must be competitive and highly technological and innovative.
Similarly, the fact that the product is washable and waterproof requires that the work team include technology experts, mechatronics, and professionals who use these objects and know how to give it an aesthetic finish so that the functionality will not be affected by an archaic and overwhelming presentation. The appearance of the flexible display on medical devices requires similar work.
Regarding the detection of emotions when offering medical services to the user, it requires that in addition to many of the professionals mentioned above, the research and involvement of experts in human emotions be included, in this case, they may be anthropologists, psychologists, and sociologists, in order to provide the topic of emotions so that the user gets a quality service and their experience is satisfied.
The feature of the medical device that can be heated requires that the co-creative work be mainly led by the engineers who handle the elements of heat with technology, so that the components are resistant and that they can be kept optimal for the use of the final consumer. In the case of the daily suggestion of medical information, it would be necessary to have the help of health experts, doctors, cardiologists, epidemiologists, and sports trainers who know how the human body works and the prevention of diseases that can give advice to patients and that this information is useful in their daily lives.
As for the green energy system, it will be necessary to have the help of experts in the field, since, in recent years, measures are being taken to develop renewable energies, and in this sense, this new knowledge can be applied to the development of the health device service. For the feature that shows the information and that is connected to the smartphone, it will be necessary to have the opinion of experts in the development of interfaces and designers of user experience to provide the information correctly and aesthetically at the same time. As for other much more technical features, such as providing the user with easy geolocation concerning the health centers around them, or the possibility of an X-ray reader included in the device, it will be necessary to have the help of the corresponding professionals in these branches of the exact sciences.
Sequencing. Following the design thinking affordability to indicate the dynamic research process, this study uses the speculative future scenario of new normal when the COVID-19 pandemic has ended. Based on it, the issue has risen and is being researched with the focus to prepare the evasive system and environment friendly by applying the currently existing technology. After that, the research compares the similar case study yet defines the perspective of both users and stakeholders to find the opportunity gap with a purpose to bring the possible chance of service in future development. While moving on to the next stage, the research involves the prototyping scenario of current medical processing to obtain trial feedback on the early development stage. The feedback also takes over the evaluation study of the whole research process. By providing milestones, focusing on the elderly, the age group that suffered the most from COVID-19, this research study builds the service process as interactive as possible while keeping the transition of every process stage a dynamical, comprehensible, and accessible sequencing for every age.
Evidencing. Visualizing tangible service to bring more impressions with the aim of attracting users to the point that they enjoy using this service repeatedly. This service aims to provide an alternative way of managing users' body health and giving daily health suggestions based on the device's data to improve their healthy lifestyle. Therefore, having the wearable device as a part of this service helps notify the user and the nearest hospital in case of emergency conditions. UX and UI of the service are considered an additional attribute that brings the more evidential feature to the users' unconscious minds. Nonetheless, the evidencing step will be distinguished in further detail within the kano model analysis based on the pretest and test survey. The kano model analysis supports this stage to see the user's priority and predict the optional service feature inside.
Holistic. This research puts holistic as the last principle to consider as a good service design product concept. Holistic design encompasses all, from the human senses, behavior, psychology to the attitudes, emotions, motivations, and so on towards the device, the service, or even a moment of experience to ensure the service has obtained the users' needs and delivers an optimal experience. This entire service experience is not limited to digital and devices. It is a combination of digital and real-world, human-computer, and human-to-human interactions. Hence by putting this principle in the research service, it can prevent even a minimum risk, as it examines all senses with different potential aspects. This service adopted the technology with the design scenario of facilitating users with the easy-to-use health care service while loosening the problems before, during, and after pandemics. The technology exposed with collecting the basic body-health data on the wearable or attachable devices to users to consider the pain point of self-individual authenticating data management. The research hypothesis can be argued that while people can manage their health, they will be more satisfied seeing that not too much effort is needed and cost-efficiency. The service also integrates with all human senses as it interacts with the human's health system.
Figure 2. Illustration of high-tech healthcare patch
A wearable device designates the forecast models which can be employed to warn the outbreak of COVID-19. Zhu (2020) has given a rise that a wearable device is not limited to body health checker but also in more advanced scenarios that can be speculated, especially during and after a COVID-19 pandemic (Zhu et al., 2020). Moreover, based on the current condition, a new trend market of smart wearable devices can also play a role as an additional device that gets along with smartphones.
This paper revealed some speculative ideas as the ultimate feature of the medical patch, as proposed in this research. The features initiate in order to occupy the needs scenario of the elderly and youngsters of using a wearable device.
The topic of innovation involves green technology for the invention of a healthcare wearable device. However, healthcare wearable devices have been well-accepted these years and exist in many forms from a bracelet, a watch to a shirt. Considering the ability to use this device repeatedly, within this paper, the concept of this healthcare device will take the form of a medical patch but a high-tech and adhesive one. Features provided in this device are considering the hygieniezation of personal medical devices since it will be used outside the hospital, especially at the users' residential places. The adhesive patch examines the best speculative medium to stick the wearable device onto the body parts instead of just wearing it. While research by Donnay (2019), utilizing the combination of cushion and the adhesive layer to secure both sides of the device and the patient's body. (Donnay et al., 2019)
Some proposed innovative features are described within the table below (Table 1):
| Features | Explanation |
|---|---|
| Reusable | Reduce e-waste |
| Waterproof, washable, cleanable | |
| Reduce virus, symptoms, damaging the product | |
| Bendable/ flexible screen display + Adhesive Medical Patch | |
| Additional screen to display suggestions and notification. A patch should not be solidly hard. | |
| Emotion detection | Emotion can affect health. |
| Online appointment and booking system with professional/hospital | |
| Quick appointment/ booking system | |
| Heat Up Feature | Inspired by the conventional Salonpas patch to attract the elderly. This feature uses heat to relieve muscle pain. |
| Daily health suggestions | Change daily health habits. |
| Smartphone integrating system | |
| Whole functions controller. | |
| Mobile medical data report | Real-time report of the user's physical and psychological health. |
| E-prescriptions system | Reduce paper waste, have AI and online professional doctors to deliver prescriptions |
| Alarm System | Emergency feature in case of faint. |
| Green Energy - Solar power energy with a rechargeable battery | |
| Using mini solar panel cells to reduce pollution and negative effects for the environment. | |
| Family integrating system. | Send medical data to family members. |
| Geolocation of the nearest medical office. | Location assistance to the nearest hospital when needed. |
| Ultrasonic imaging | Works as a X-Ray function to self-scan the user's body. |
Table 1. Features of high-tech medical patch
User journey map
A user journey map contributes to the user-centered design's clearer image, which defines the pain point of interaction between the stakeholder with the product. In this user case, it is assuming that a 60-years older adult with some health issues using this product to relieve and to manage his health:
Figure 3. User journey map
The medical patch provides some features to solve the user problem in reminding the symptom on his body. With the shape and interface that approach the traditional patch, this medical patch gives the same feeling, so it will not make the elderly get disturbed by the high-technology attached to his body. The system built in the path will manage the user body's report and also the additional suggestions based on it. However, if the unwanted health symptom attacks the user, the system is going to notify the registered account of the relatives, yet gives additional warning to the user about the current urgent condition. Besides, in this scenario, Mr. Alex Wong has a monthly check schedule, which takes him to travel to the hospital at a certain time. The attached patch provides a service for doing online reservations and phone-based prescription; therefore, the user can predict and save the time of line up in the real scenario. The forecasting experience received by the user is gradually increasing; it is visualized by Figure 3. User journey map.
Speculative futures and alternative presents
The speculative design considers the value of one particular solution or development of technology to enable a vision of its applicability in solving an anticipated problem while, at the same time, presents the design proposal that can employ present-day technology in an alternative direction. Imagining the effect of here and after, Speculative Design uses the 'What if' element and makes a design concept that seems unreal or dubious. Yet, it steadily forms the possibility of fiction from impossible into reality.
In Speculative Design, the values or the methods that create inspiration and the audiences are the key factors that lead to the discussion of the fictional concept features of a service. For the concept to gain approval, it has to pass as real. Therefore, the perception of today's lifestyle observes the psychological issues, especially to elderly users, the adhesive patch examines the best speculative medium as mimicking the traditional patch that is mostly used. This research exposed some medical ideas as the innovative features of a high-tech medical patch. This innovation topic involves eco-technology to the invention of a healthcare wearable device that is reusable medical eco-technology. While taking the form of a traditional medical patch, it is a high-tech and adhesive one. Features provided in this device consist of the hygienization of personal medical devices, since the user's residential places are the prominent spot of using the device. Then apply the ability to stick the wearable device onto anywhere of the body parts instead of just wearing it on the wrist. Still, to testify these concept features, these speculative features through the Kano Model approach.
Kano model
Kano model analysis is a tool to understand the perception of users with testing what they intend to offer in the future. Adopting Kano model analysis, this research builds the way of implementing health and technological innovations to develop future better service and quality.
Based on the speculative idea of designing a new environment after being affected by the COVID-19 pandemic. The questionnaire was done twice as the pretest and test of the qualitative method. The pretest was used as the first analysis and evaluation to narrow down the general idea of features that will be proposed in the test-questionnaire review. While the test works for real analysis to understand the users' needs of each features' quality. The total reported participants on the questionnaire were 34, which split by 16 of the pretests, and 18 on the real test. The analysis of this method was concerned with four categories of Must-be, Performance, Attractive, and Indifferent. Therefore, based on the Kano concept analysis, the report is also distinguished by two kinds of discrete analysis and continuous analysis.
Kano model questionnaire-pre-test analysis
The implemented Kano questionnaire helps us to know the perception of the users, and in this sense, the project of "Wearable devices" was explained to our sample to put the user in context and to give their point of view, as accurate as possible, imagining as if the product were available on the market now.
The order of the questions was as follows: To start, the interviewee was asked about 1 of the features that "Wearable health devices" have, get their opinion and know what they thought if that characteristic were offered in the final service, in other words, how essential the user considers that this first characteristic, which is "tracking," is offered in the final product.
The answer options for this first question were among five gradual rating options, ranging from the least important "I dislike it," gradually rising with "I can tolerate it," then "I am neutral," then "I expect it," and at the end reaching the highest-ranking "I like it."
After this first question, it was sought to know the user's opinion about their perspective related to the same feature "trackable," what they think if it were not included in the service. The answering system was the same as in the first question, going from "I dislike it" to "I like it."
For the third question, the same previous system was repeated, asking the opinion about the second feature of what the service intends to offer, "wearable," and the point of view on what the user thinks about including it, going to the next question about the opinion of not including this feature
In the same way, the following questions were implemented, asking about the characteristics of the service: "online appointment" to be able to make an appointment with the doctor without the need to wait in line at a hospital, having a higher risk of contagion or infecting others during the waiting; then "see your results" in real-time, the moment the doctor obtains the results, the patient can see them at the same time; and finally, the feature of "aesthetic design," that may provide certain tranquility and health security feeling to the user and probably they are more likely to prefer wearable aesthetic products than those that may offer the same service, but with a non-aesthetic design
The questionnaire was developed to obtain information about the five features of the service, resulting in a total of 10 questions, and it was implemented to a sample of 16 participants.
Figure 3. Evaluation table
Each of the responses was classified in the evaluation table of the Kano model to be able to rank each of the features and classify them in
In this way, it can be known four different categories for each of the attributes that the service of "Wearable Devices" offers, thus obtaining the possibility of results that the characteristic is "Attractive" or that this characteristic is a "Must" that be included, or that the user is "Indifferent" if it is included or not, or resulting in the most important "Performance," which means that the offered feature exceeds the user's expectations and it is essential to include it if you want to offer a service quality.
Each of the responses was classified in the evaluation table of the Kano model. In this way, the four different categories for each of the attributes that the service of "Wearable Devices" offers can be known. Thus obtaining the results that the characters could be "Attractive" or that this characteristic is a "Must" that be included in the service, or that the user is "Indifferent" whether it is included or not, or resulting in, the most important of the attributes "Performance," which means that the offered feature exceeds the user's expectations. It is essential to include it if it is wanted to offer a quality service.
There are also another two more categories. One is "Reverse," which means that when asking the user, the order must be reversed in order to obtain one of the categories explained before, and finally the category of "Questionable," which means that the answers that the user is giving for this feature are contradictory, probably because they did not understand the question that was asked or because they were not entirely attentive in answering and was distracted for some reason
The results were analyzed from 2 perspectives, the first is a Discrete Analysis, and then a Continuous Analysis. The results obtained with the Discrete Analysis were the following:
Pretest analysis
In the design service of "Wearable Health Management" devices. It is intended to offer a service with two "Performance" features, one "Attractive" feature, one for the "Must" feature, and one for the "Indifferent" feature, but the results obtained made it clear that users' opinions may be different from what the designer's plan.
Discrete analysis. The best results for this service project were obtained with the Discrete Analysis in the second test: for the first feature of the service "Trackable" it was seen in a very positive category "Performance"; the feature "Wearable" resulted as "Indifferent"; the "Online Appointment" and "See your results" feature as "Attractive"; and finally, the "Aesthetic" feature resulted in a "Must."
Although initially it was sought to obtain two results for performance, 1 for Indifferent, 1 for Must, and 1 for Attractive, the results that were obtained here give a determining perspective to differentiate the opinion of the users about the features, and it helps categorize them for better service design.
Table 2. Discrete pretest analysis
Continuous Analysis. The Continuous Analysis was made, but the information obtained does not help when categorizing the features. At the end, 5 of the 5 "Features" resulted as "Attractive," and here they cannot be determined or ranked.
Table 3. Continuous pretest analysis
Similarly, the level of importance obtained in the results was quite similar to each of them, resulting in an average between 6.68 and 7.42. With these numbers, the level of importance of the five features was quite similar and with a not very determining hierarchy
Figure 4. Kano Model Pre-test
Kano model questionnaire - test analysis
The results obtained in the pretest questions were very ambiguous and insufficiently determinant in order to develop the service design of "Wearable Health Devices," and it is difficult to see trends in the opinions of users clearly and distinctly. Therefore, the second survey was conducted with enhancing and narrowing down the feature into 15 kinds so that users can see the suitable needs from their perspective. The participants were separated based on their educational background as Engineering, Business, and Design.