Fairness First Blog

Researchers’ voices in health equity

The Fairness First blog represents a space where researchers share with the broader community why health equity research matters to them, how do they connect to health equity, and what is the value of community engagement in the research process.

May 24, 2024

Using Play to Address Health Inequities

A discussion with researchers from the Playful Health Technology Lab

This month we’re observing Speech-Language-Hearing Month. Organized by the American Speech-Language-Hearing Association, May is a time to encourage dialogue and share resources about communication disorders and the role speech-language pathologists and audiologists play in providing care. This month’s blog features researchers and students at the Playful Health Technology Lab, led by Dr. Jared Duval. Applying a holistic approach to health and play, the team creates technologies to meet the needs identified by the communities they engage with.

About the Researchers

Dr. Jared Duval is an assistant professor in the School of Informatics, Computing, and Cyber Systems and the director of the Playful Health Technology Lab. He grew up in a small town in Massachusetts and completed his PhD in Santa Cruz, California. Dr. Tochukwu Ikwunne is a postdoctoral scholar in the School of Informatics, Computing, and Cyber Systems at NAU. Originally from Nigeria, Dr. Ikwunne completed his PhD in computer science at Trinity College Dublin before coming to Flagstaff. Chaithanya Heblikar is from India and is completing a master’s degree in computer science. Both undergraduate sophomores, Chaithanya Heblikar and Hunter Beach are participants in NAU’s Interns to Scholars Program. Alison came to NAU from Monterey Bay, California and Hunter grew up in Mesa, Arizona. Funded by SHERC’s Pilot Project Program, the team is working with speech-pathologists and community partners to address accent-related biases in SpokeIt, a phone-based game app that provides speech therapy in remote settings and underserved communities.

About the Research

JARED: The mission of the Playful Health Technology (PHT) Lab is to engage and work with communities to help them achieve their goals. It’s really important that we set down roots in the community, create partnerships, and work together to develop problem statements and work towards building systems. I am in a computer science focused department so my research is focused on technology. We work primarily with people with disabilities but we’ve also worked with communities on digital equity for increasing internet infrastructure understanding so that investments can be made in more rural communities to help bridge that divide. We take a broad and holistic approach to the definitions of both health and play. Health is not just the medical model of wellness – we consider all of the factors that contribute to a person’s happiness and a life well lived. Play can be anything that brings joy, makes us forget about time, and is pleasurable.

One of the projects we have going now is the SHERC-funded Pilot Project. The goal of this project is to take our existing speech therapy game, SpokeIt, and ensure that it does not have bias in its speech recognition systems against anyone in the southwestern United States who might have a Spanish or Indigenous accent, while still being a tool for diagnosing critical speech errors. Another project we’re working on is a phone application called Disabled Makers, which is meant to create a crowdsourcing resource for people with disabilities to engage in makerspaces* in local communities. I’ve worked with Tynkertopia (Flagstaff’s makerspace for children) and the Coco-op, which is the community-led makerspace for adults where I also teach pottery. We’re interested in better understanding how we can make those spaces more accessible to people with disabilities and support projects that they’re passionate about. We want to enable them to have a platform where they can share their knowledge about the projects they’re working on and share it so that other people can benefit as well. We’re also hoping that these projects help people in a marginalized community build STEM skills so that they are able to run their own disability-owned businesses out of makerspaces.

*Makerspaces: Collaborative work spaces that are typically located in a community setting such as a school, library, or public facility. Makerspaces often focus on experiential learning and provide resources and materials for creating.

TOCHUKWU: My research focuses on the interplay between game technology, technology competence, and health and how technology can mediate between health and human behavior. I like to use a hands-on approach. This means involving end users* and trying to understand their pain points and needs, and then designing digital interventions that will help reflect their values and needs. I’m also looking at how digital health interventions can be designed to improve user engagement by capturing the needs and cultural contexts of different users. This is especially important in settings where people are marginalized and in global contexts because many technologies do not always capture sociocultural contexts.

*End users: People who use a product or service.

HUNTER: As part of my work with the PHT Lab, I’m helping to make a web application that will connect speech-language pathologists to the recordings we get from the test of the SpokeIt project. Using the recordings, speech-language pathologists will be able to determine how well our speech recognition system is working. I’ve only recently started working on this project, but I’ve been enjoying developing the website and learning related skills.

CHAITHANYA: I’m currently working on the SpokeIt application. The app is currently implemented in iOS* so I am working on adapting it to Android* devices using a development platform called Unity Framework.

*iOS and Android: Operating systems used in mobile technologies, typically smartphones and tablets.

JARED: For context, we’re making SpokeIt available on Android to be more equitable. Androids typically tend to be cheaper devices.

ALISON: Right now, I’m focusing on design-based work, including some graphic design, although I usually focus more on data. Once we get to the point where our speech pathologists can analyze the system and tell us how well it’s working, I’ll be able to take that data and use it to create impactful graphics that show where our project is going and how we can improve it.

Allyship Through Community Engagement

Community engagement and allyship are top priorities for the members of the Playful Health Technology Lab.

JARED: There is a book – Nothing About Us Without Us: Disability Oppression and Empowerment – that encapsulates the idea of community engagement and allyship really well. It’s about not being empathetic but being with people. Rather than trying on somebody else’s disability, it’s about partnering with people with disabilities. In the context of designing assistive technology, allyship is about removing systematic barriers and doing the work that can solve some society’s biggest wicked problems.* This can mean engaging the community, working on a smaller scale, and building better models that are more representative of the people that live in these communities. We can think about how a project can be generalized to larger contexts to help other people and use both quantitative and qualitative data to understand health patterns and create more diverse understandings of health.

For the SpokeIt project, we’re working with Smile Train who have lots of connections to the communities around here. Smile Train is an international organization that provides resources to local medical professionals who focus on cleft palate surgery and health. We’re also working with the Native American Cultural Center on the NAU campus to build partnerships, and we’ve started working with the Hozhoni Foundation, Flagstaff’s local disability provider. This will be a mutually beneficial partnership that will allow us to engage directly with different populations of people with disabilities in northern Arizona and have them try out and build tech with us.

*Wicked problems: Challenges and concerns – often social – that are difficult to solve. Examples include education design, climate change, and poverty.

TOCHUKWU: The PHT Lab has been active in supporting designs for marginalized people. I’ll use one of our other projects, CardioCare Quest, as an example. CardioCare will use game technology to improve blood pressure and help patients follow their treatment plans. For this project, we’re focusing on tribal communities – primarily Navajo and Hopi. The first thing we did was engage with community members to begin building trust. We met with the Native American Cultural Center at NAU and participated in a SHERC-supported Community Engagement Studio to gain feedback directly from community members on our research design. We’ve also navigated the tribal consultation process. Allyship and trust are very important to the context of our research.

Aligning Technology with a Health Equity Lens

Health equity means that all people have “a fair and just opportunity to attain their highest level of health.”

JARED: Developing technology is a privileged and complicated set of skills and tools and I think society would benefit from extending these skills to everyone. My research is less about the actual development of technology and more about identifying how we can work together and share these skills so that people’s goals can be achieved even if they don’t have a computer science or similar degree. Again, I think it’s so important to use a holistic definition of health when we’re talking about technology because it’s easy to fall into a “let me fix you” mentality, which is against the ethos* of our lab. Health is more than just your physical well-being. By thinking about health as a variable at a single point in time we can frame it as a skill that can be improved. Ultimately, research and technology matter because they have the ability to give power to people who don’t have the same opportunities that I’ve had.

*Ethos: The beliefs or ideals that guide a person or group.

TOCHUKWU: I think the research conducted by the PHT Lab matters a lot. You can imagine a parent’s reaction when their kid plays the SpokeIt game and receives the care they need. The research we do helps make people feel happy. Our goal is to create technology that leads to positive impacts for the people we work with and the research we do aims to help people overcome challenges in ways that work for them. This makes our research relevant not only in Arizona, but the broader United States and even around the world.

HUNTER: I’m far from an expert on health equity as I’m just getting into this research and concept, but one thing I have learned from this internship is that a lot of speech therapists have waiting lists. There are many children who want speech therapy but cannot access it. The free SpokeIt software will help people get the assistance they need to reach their goals, even if they have limited access to traditional speech therapy.

CHAITHANYA: I’m also just starting out, but I believe that by providing the SpokeIt application in both iOS and Android will make it reachable for diverse communities and be cost effective for people who cannot afford more expensive devices.

ALISON: I grew up in an underprivileged area and speech therapy wasn’t seen as a necessary health intervention. It’s great that this research and the SpokeIt app are making it a more accessible health benefit that people can access. I think this work is going to help to make speech therapy a priority in more people’s lives. Hopefully, people will start seeing speech-related disabilities as something that they don’t have to live with and suffer through. You can get help and it doesn’t need to be a costly process. It can be as simple as playing a game.

Personal Perspectives

Understanding your “why” can be a powerful tool for engaging in meaningful and equitable research, particularly in community-engaged settings. Many researchers reflect on their positionality – a concept that refers to a person’s social identities and how these identities shape the way we experience the world  – and their relationship to the topics they study and the people who participate in their research. Here, the team reflects on why their research resonates with them personally.

JARED: Working with people with disabilities was kind of the family business. My brother works in special education, my mom is a case manager for the Department of Human Services in Massachusetts, and my dad is a shared living provider.* We had people living with disabilities living in our house with us for many years and I grew up in the context of helping people with disabilities. I was also a respite nurse while I was going through college. While I really enjoyed helping people feel better, I wanted to help more people at a larger scale. I got a degree in computer science to help me do this and then I found this awesome graduate program at University of California, Santa Cruz. The program – Computational Media – bridges the arts and humanities with computer science. It helped me solidify the idea that games and play are great vehicles for bringing about health change because humans are biologically engineered to learn and grow our skills through play. I think play is one of the most important things we can do with our lives.

*Shared living providers offer training for social and independent living skills in a family setting for people with developmental and/or intellectual disabilities. Residents receive support while living as independently as possible.

TOCHUKWU: I am passionate about learning how new things work. I also like seeing happy people and doing what I can to help make them happy, especially people in underserved settings. What made me decide to pursue this research is the methodology that the Playful Health Technology Lab uses. Through research and design, we’re able to understand the people that we are working with. We can design for them and with them. Once you design with people, you understand their needs. Part of the research and design process is practicing empathy. Through empathizing, you get to know more about the people that you design with. This connection builds trust and allows for deeper collaboration. I feel most happy when I see that the end product is making people feel good.

HUNTER: I was very interested in speech therapy because I have a speech impediment myself. It’s called rhotacism and it means that I can’t say the letter “r” very well. I struggled a lot with this when I was younger, and I started speech therapy when I was in first grade. I liked the idea of making a speech therapy game to help kids who don’t have a chance to go to speech therapy. Like Jared, this is somewhat of a family business for me. Both my brother and mother are physical therapists and that’s why I’m really interested in health. My mother uses a lot of play and games in her physical therapy practice. It would be cool if I could design something to use in a physical therapy setting. It’s a dream of mine.

CHAITHANYA: I joined the PHT Lab because I always wanted to do something which would have a positive impact on the community. During my undergrad, I was always involved in activities that helped the community around me and I engaged with NGOs during the COVID-19 pandemic. I had some experience in Android development so I reached out to Dr. Duval when I saw that the PHT Lab was looking for someone to work on this project. I think it’s amazing that the SpokeIt app helps kids with speech therapy. I’m very excited to be a part of this project.

ALISON: I was initially interested in the Lab because I was also a speech therapy kid. I remember reading the description of SpokeIt and thinking, “wow, this is a really great thing that they’re developing.” I saw how connected the project was to other work I was doing and it drew me in. I love how this research has the potential to make a difference for so many people.

Merging Health and Technology: Opportunities for Change

Here the team responds to the question, “What excites you most about the intersections between health and technology?”

JARED: As a field of computer scientists and engineers, we haven’t done a great job at finding authentic problems to work on and we typically come to the table with a solution. There’s this idea of techno-solutionism which refers to fixing something that was never actually a problem or you understood the problem incorrectly. By learning from other disciplines like the arts and humanities, we can be better at using technology as a vehicle for good. A lot of the technology out there today is built under a capitalistic agenda. I’m most excited about working in this area because I think technology can do just as much good as it can do evil. We need to be strategic about how and when we use it and realize that there are some places where technology shouldn’t exist.

TOCHUKWU: I’ll start by telling a story. A couple of years back, a friend of mine went to the hospital and waited for so long that he started thinking about how inefficient the hospital was. He eventually left the hospital without being seen by a doctor. Reflecting on this, I considered how technology can help solve the problem of long hospital wait times. The thing that’s exciting to me is the potential for interplay between technology and health interventions. In the PHT Lab, we encourage interdisciplinary research that allows us to better use technology to improve health. This approach gets me excited about the work we do.

HUNTER: What excited me about the intersection between health and technology is game development. It’s always been a passion of mine and I want to learn a lot more about game development here in the PHT Lab. Like I previously mentioned,I want to make some sort of playful health technology that could be used in physical therapy.

CHAITHANYA: I’m interested in the potential for technologies to be available in remote areas. I can do what I need to do online and don’t have to worry about traveling.

ALISON: I’m excited about the opportunities to approach health through multiple disciplines and open the field of computer science to new ideas. In addition to making healthcare more available nationally and in underprivileged and low-income communities, using technology in healthcare opens up global opportunities and encourages global collaboration. It’s exciting to see how technology can bridge gaps in health and motivates people to collaborate more.

Good Food, Staying Active, and Friendship

Self-care is a vital part of our collective work towards health equity. The researchers discuss how they take care of themselves outside of research, work, and school.

JARED: I am a very good cook and I really love to eat. That’s one of the things I do most frequently to take care of myself. I also really like teaching and creating pottery because it helps ground me.

TOCHUKWU: To care for myself spiritually, I go to church every Sunday and meet with my friends. We look forward to seeing each other and provide support to each other. I’m also enrolled in physical therapy at NAU and I go every Tuesday.

HUNTER: There are three things I’ve been focusing on recently. When it comes to homework or studying, I’ve started using the Pomodoro Technique.* This has been good for me because I used to give myself no time for breaks or games. It does a lot for my mental health. I’ve also been doing a paddleboard yoga class at NAU for fun. At the end of the class, you lay down on the paddleboard and think about what you’re grateful for. That’s been making me feel more positive. Lastly, I make sure I get a minimum of six hours of sleep a night.

*Pomodoro Technique: A method for managing time where a person uses a timer to break work into 25 minute blocks with short breaks in-between. People typically take a longer break after several 25-minute sessions.

CHAITHANYA: I really like dancing so I make sure that I attend at least one or two sessions of the dance fitness class offered at NAU’s Recreation Center. I also enjoy spending time with my friends. I play racquetball with them, primarily on the weekend. This takes my mind off of college work and refreshes me.

ALISON: I’m in a sorority on campus. While this sometimes stresses me out, one of my go-to ways to unwind is to hang out with my sisters. I’ve always got a few sisters on speed dial who I can call up after work to hang out or get coffee with.

Interested in learning more about health equity research at NAU and in the community?

Visit CHER’s social media for short stories that highlight SHERC researchers, students, lab spaces, and more! Look for “Fit it in a Minute” posts.