Health Technologies ‘In the Wild’: Experiences of Engagement with Computerised CBT Stefan Rennick-Egglestone 1 , Sarah Knowles 2 , Gill Toms 3 , Penny Bee 4 , Karina Lovell 4 , Pete Bower 2 1 Mixed Reality Laboratory, School of Computer Science, University of Nottingham, UK 2 Centre for Primary Care, School of Primary Care Research, University of Manchester, UK 3 Research in Ageing and Cognitive Health, School of Psychology, Bangor University, UK 4 School of Nursing, Midwifery & Social Work, University of Manchester, UK stefan.egglestone@nott.ac.uk, sarah.knowles@man.ac.uk, gill.toms@gmail.com, penny.bee@man.ac.uk, karina.lovell@man.ac.uk, peter.bower@man.ac.uk ABSTRACT The widespread deployment of technology by professional health services will provide a substantial opportunity for studies that consider usage in naturalistic settings. Our study has documented experiences of engaging with technologies intended to support recovery from common mental health problems, often used as a part of a multi-year recovery process. In analyzing this material, we identify issues of broad interest to effective health technology design, and reflect on the challenge of studying engagement with health technologies over lengthy time periods. We also consider the importance of designing technologies that are sensitive to the needs of users experiencing chronic health problems, and discuss how the term sensitivity might be defined in a technology design context. Author Keywords Health technology; CCBT; mental health; user experience ACM Classification Keywords H.5.m. Information interfaces and presentation (e.g., HCI) INTRODUCTION The design and evaluation of technologies intended to support recovery or management in relation to chronic health conditions has become a significant strand of HCI research. Much of this prior work has been structured around the design of prototype technologies which have been evaluated through relatively small-scale, controlled deployments. However, Blandford [8] has argued for research that engages with health technologies in a realistic context of use, and prior experience suggests that the study of deployments “in the wild” will reveal complex and unexpected phenomena that can only emerge in naturalistic settings [7]. Some health technologies have reached a sufficient level of maturity that they are being deployed on a wide-scale by national health services, and this should provide a broad range of opportunities for research studies that consider usage in naturalistic settings. In the case of chronic health conditions, these might need to consider engagement across a multi-year period; how to study such engagements effectively is then a challenging question. The focus of this paper is on Computerised Cognitive Behavioural Therapy (CCBT), a class of technology which has been deployed by major health services for a number of years, and which has been designed to support recovery from common mental health conditions such as anxiety or depression. Though a substantial amount of quantitative research into CCBT has been conducted, research that documents the experience of engaging with CCBT as part of a broader treatment process is much more limited. So as to obtain a rich understanding of this experience, we have worked with a group of participants with extensive prior experience of using CCBT, who have contributed a detailed set of reflections on their usage. To allow us to contextualize interactions as part of the broader experience of recovery, this material was captured through two reflective workshops. These were carefully structured to collect rich and detailed recollections of experience, and to discuss participants’ current understanding of these. Our analysis draws attention to some important phenomena that can only be fully understood when specific experiences are contextualized as part of a multi-year recovery process. Examples include the profound impact of cognitive difficulties associated with mental illness on early interactions with technologies, and the challenge of designing technology for users who are experiencing deep and pernicious levels of despair. Our work also draws attention to the challenges encountered during the early stages of engagement with CCBT and the need to provided effective support for disengagement at the end of a period of treatment. The latter two issues are both highly relevant to the design of effective health technologies more generally, and we discuss them in detail. © Rennick-Egglestone et al. 2016. This is the author's version of the work. It is posted here for your personal use. Not for redistribution. The definitive version was published in the Proceedings of CHI 2016 (San Jose, CA, USA, May 2016). http://dx.doi.org/10.1145/2858036.2858128.