The Life guide

Jon Sutton interviews Lucy Yardley (University of Southampton) about falls, health interventions, prosopagnosia, and more

You trained and worked as an audiological scientist. How did that influence your career in psychology?
My experiences assessing and treating dizzy patients inspired the research I carried out for my PhD and for the next 10 years. I felt that while pain has several journals devoted to it, dizziness – which is nearly as common and very distressing – is hardly researched at all, especially by psychologists. Also, there are very simple exercises that can help many people with dizziness, but hardly any patients get to know about them, and it has been my lifelong ambition to make these exercises available to everyone who needs them.

I have just completed my fourth clinical trial showing that they work – each time I do this I try to find an effective and practical way of delivering the exercises, so that eventually this treatment might become more widely accessible.

You seem pretty eclectic in your approach – you advocate mixed methods, you have an interest in both traditional and complementary therapies, you research traditional and ‘cutting edge’ interventions.
I have a ‘pragmatic’ philosophical approach to research, which means I am happy to combine any methods that seem useful – and I do find it interesting to explore topics in different ways. For example, when I first started researching biopsychosocial aspects of dizziness, I wanted to understand every aspect, and since so little had been done in the field it seemed to make sense to approach it from many different angles. This allowed me to build up a more complete picture of the interlinked cognitive, behavioural, emotional and physiological problems people with dizziness face and how to help with them.

Is there a downside to being that eclectic?  
Well, the more approaches you use the harder it is to keep on top of the literature in each field, but it can help your work to remain innovative by making fresh connections.

With the research into the prevention of falls, presumably you’re working with the elderly a lot. But I suppose preventative work requires quite a lifespan approach? From experience with my dodgy knees I know how important balance and gait can be, and I wish I’d done more work on it as a child.
The good news is that it is never too late to improve your balance and gait – in fact, my work on falls prevention led quickly to the conclusion that everyone should undertake activities to improve their balance and gait as they get older – both people who think they have no problems (but are probably starting to have slightly less good balance) and people who have poor balance and don’t realise they can improve it. The same principle applies to what I call ‘perceptual–motor fitness’ as cardiovascular fitness – in both cases you can build up your capacity quite quickly even in later life – but also lose it quite quickly if you become inactive. Older adults can improve their balance effectively by activities such as t’ai chi.

I’m trying the Wii balance board! I suppose technology – the internet, texting, etc. – plays quite an active role in shaping your research? You never know what ‘the next big thing’ could be, and the opportunities that might afford for intervention.
Much of my work has been focused on finding low-cost, easily disseminated ways of empowering people to self-manage their health conditions wherever possible – and the internet potentially seems ideal for this purpose. My first web-based intervention was actually to inform older people about how they could improve their balance. I quickly realised that a downside to web-based interventions was the need to rely on software developers to create them – and so three years ago I obtained funding from the ESRC Digital Social Research Programme to create LifeGuide, which is a set of free software tools anyone can use to create web-based interventions, without the need for programming skills. Now lots of LifeGuide interventions are being created for all sorts of health problems – there are over 500 members of the LifeGuide community worldwide, with more joining every week.

Nowadays we are all starting to use our mobile phones to access the web – can LifeGuide interventions be delivered by phone?

LifeGuide interventions already send simple automated text messages, which can be timed and personalised to fit the user’s lifestyle and progress. In fact, a review of all web-based interventions we published recently showed that web-based interventions that include text messaging are nearly twice as effective as those that don’t. And I have now secured funding from EPSRC for ‘UBhave’, which is a new three-year project to exploit the potential of smart phones for interventions. UBhave is a joint project with the University of Cambridge, who are developing ways to measure where users are, whether they are moving about, who they are with and what they are feeling. We will be working together to build and evaluate tools for creating interventions that deliver ‘just in time’ advice on the move.

That sounds like a lot of information to gather with just a phone!
We will just be using the standard sensors you get on any modern smart phone. For example, Bluetooth can tell you if someone else with a phone is nearby, and the Cambridge team have already developed ‘Emotionsense’, which can detect mood with reasonable accuracy from people’s tone of voice when speaking on the phone. In UBhave we will also need to put together some clever software to turn the phones into detectives that piece together what people are doing from lots of different clues, as well as information they have input, such as where and when they work. I’m sure we will get it wrong half the time at first – the trick will be to find out which situations we can detect most reliably.

Can the power of social networking play a part in self-management of health?
We know that social influence and support has important effects on health-related behaviour, and so it certainly seems likely that online communities could play a useful role, but we don’t know enough about how to harness this support yet. Actually, the UBhave project will be exploring this too. We plan to test our tools and methods out by combining sensing smart phones and social networks for a weight management intervention. The idea is that users who want to lose weight will plan online in advance when they most need help, what kind of help they want, and which people will be in their virtual support network. For instance, they may say that they need support when they are lonely and bored, or when they are out for an evening with friends. When the phone detects that they have been at home alone and inactive for a couple of hours and have low mood, this might trigger a link to their virtual social support community, or an automatic text prompting them to get out and do their preferred physical activities. But if the phone detects that they are in town in the evening, moving around with other people and in a good mood, then they might be sent their planned reminders of acceptable ways to refuse or find a substitute for fattening foods and drinks, plus links to online calorie-counting websites so that they can look up how many calories alternative dishes have in them.
 
It sounds a bit like a series of ‘nudges’ to better health. What are your views on the rise of the ‘nudge’ culture of behavioural change in government?
I have read the book that has popularised the ‘nudge’ approach and was unimpressed. It just seemed to mix up lots of principles of information processing and behaviour change that have been taught to every first-year psychologist for decades – so many of the principles are sound, but the way they are being promoted doesn’t seem to represent a coherent or new approach. There is also a widespread concern that the government may prefer to ‘nudge’ individuals’ decisions when what would be much more effective for public health is concrete social action. A good example is raising the price of alcohol, which is known to be much the most effective way of reducing alcohol-related harm.

But I have to admit there is one sense of the term, if you take it out of its current political context, that I do quite like – the idea that instead of trying to make people regulate their behaviour through rational planning and effortful conscious control you can help them live more healthy lives by using environmental ‘nudges’ in the right direction, which still leaves them free to choose to ignore the nudge if they want. This is how I see our mobile phone intervention – in a world where the whole food business is shoving you towards eating unhealthy foods instead of just relying on willpower with no support you will be able to create your own mobile environment that nudges you back in the direction you want to go.

I can see the upside of your phone interventions, but aren’t you worried about the downside – it all seems a bit Big Brother.
Ever since we created LifeGuide people have been asking us whether we are worried about unethical uses of it. But to me LifeGuide is just a tool that can be put to either good or bad use – like the printing press, which has been used to disseminate the Bible, the teachings of the Buddha, The Communist Manifesto and Mein Kampf. So I think it is for the people who create interventions using LifeGuide to take responsibility for whether what they create is ethical. In the case of our weight-management intervention, people will only use it after giving fully informed consent, they can stop at any time, the data will be totally secure and private, and we will encourage maximum autonomy and choice – and we will do lots of qualitative research to check that people do not find it intrusive or worrying. But it’s true that some of the techniques we plan to use are already being used by advertisers and companies for commercial motives, without all these checks and balances.

I know you’re prosopagnosic. Has that affected your working life?
Although people with acquired prosopagnosia find it devastating not to recognise familiar people’s faces, if you grow up with it then it just seems normal. It does make conferences difficult because of the constant and realistic anxiety that you will inadvertently offend colleagues by failing to recognise them after meeting over many years! But a UCL website with a test for face blindness empowered me to self-manage this problem a few years ago – at least now I can explain why I may appear to be rude and unfriendly.

Find out more
For more information, see http://www.soton.ac.uk/psychology/about/staff/ly3.page
To join the LifeGuide community and download the free software just go to www.lifeguideonline.org

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