case study

SPAM - coordination in residential care using SMS

see page 673. Design Focus: SMS in action

In a town in the North of England, the Croftlands Charitable Trust run a hostel and associated semi-independent living accommodation for former psychiatric patients. Under the UK governments 'care in the community' programme many long term psychiatric hospital wards have been closed and instead the former patients are being reintegrated into the outside community. Most need support on either a temporary or permanent basis and the hostel and accommodation offered by Croftlands is one of many such establishments across the country.

Studying and designing in an environment like this is hard and cultural probes were used alongside more traditional methods such as focus groups. A recurrent problem for staff at the hostel was keeping in touch with one another as they are often away at meetings, on trips with patients etc. After seeing a demonstration of the Hermes system the staff expressed a wish to have something using some of the same technology, in particular to allow them to use SMS messaging to keep in touch.

The resulting system was called SPAM (although they have perhaps regretted the name since, it has stuck!) Staff and patients have a single number that they can send SMS messages to. All SMS messages to this number are displayed on a touch screen in offices at both the hostel and semi-independent accommodation. Staff at the office can reply to the SMS using the interface.

The display is quite simple with messages appearing in a list, but has some quite subtle design constraints. The office is used by the staff only, but patients may come to the office to make enquiries. However, the messages sent using SPAM were sometimes confidential and so needed to be small enough on screen to be unreadable form a distance, yet large enough so that at a glance the staff in the office could see when new messages had arrived. There is often such a conflict between ease of use and privacy and there are similar issues with Hermes.

As well as the sensitivity needed working with patients some of whom suffer from schizophrenia or paranoia, the system had to be very dependable. The staff were relying on it as part of their day to day work. Where there were choices often the system was designed to be simple rather than adding many features. Also if things do go wrong the system was designed to restore itself by simply rebooting the PC it operates on.

One particular dependability issue was due to the unreliable nature of SMS messages. Often SMS messages are delivered nearly instantaneously. However, SMS messages are not guaranteed to arrive within any particular timescale ... or even necessarily to arrive at all! (You may become more aware of this if you use texting in different countries where the SMS messages often have to go all the way back through your telecoms provider in your own country.) To ensure that senders can be confident that messages have arrived, the SPAM system automatically sends a confirmation SMS back. The sender knows that if they get a confirmation then the message has arrived safely and is displayed on the screen.

Although the number was only known by a small group of people there were still some problems on 'nuisance' messages. To prevent this the system allowed some numbers to be blacklisted so that SMS from them was not displayed on the system. Note that to ensure use the system needed to take into account quite rich and detailed aspects of the particular context.

As part of the deployment of SPAM data was collected and studied (subject of course to suitable agreements and anonymisation). The system is indeed successful in that it has part of the day to day working of the Croftlands staff and is often used for 'mission critical' aspects of their work, for example, if a member of staff has been delayed at a meeting or by traffic and will not be able to meet a patient at a prearranged time. However, the development team knew that SPAM was really a success when they saw a joke in the SMS traffic - the users had really appropriated it and made it their own!

SPAM is now stretching out beyond the office and one of the Croftlands staff now has a unit in his home based on a modified XBox!

For interest ...
Did you know that the low level IP protocols used in the Internet are also unreliable? Higher levels surround this with automatic checks, resending lost data, so that you are not usually aware of this as a user. With SPAM this could not be hidden and instead the interaction had to deal explicitly with the unreliability.
read more about SPAM:
Keith Cheverst, Karen Clarke, Dan Fitton, Mark Rouncefield, Andy Crabtree, and Terry Hemmings. 2002. SPAM on the menu: the practical use of remote messaging in community care. SIGCAPH Comput. Phys. Handicap. 73-74 (June 2002), 23-29. DOI:10.1145/960201.957210


text - Alan Dix © 2004
photo - Mark Rouncefield © 2002