Action Intention Gap
This month, I marked my six month anniversary as a researcher at Core Human Factors. I started at Core after finishing a Masters in Behavioral and Decision Sciences last summer and have been reflecting on the overlap between my graduate school experience and the work that we do at Core. A large component of my education and training was seeking to explain what drives human judgement, decision-making, and behavior. I continue this work at Core when exploring the root causes of use errors.
Intentions are an important component of understanding why people make certain decisions. Decision-making expert Jonathan Baron describes rational behavior as behavior that aligns with individual goals [1]. For example, if someone decides to jump out of a plane, they are behaving rationally if they acted in pursuit of a thrilling experience. For others (including me!), deciding to skydive would be highly irrational because we generally aim to avoid unnecessary risks and don’t seek terrifying situations. In the realm of medical human factors research, device designers and users both align on a common intention: the delivery of safe and effective treatment. Unfortunately for the device designers, there is sometimes an apparent mismatch between the users’ intention and their behaviors, which can lead to harm in certain situations. For an example, see the images below. Figure 1 shows a clear instruction for administering a dose of epinephrine. Figure 2 shows a common use error with the epinephrine pen injector, injecting into the thumb.
Figure 2: Use error of an epinephrine pen, injecting into the thumb [3]
Some action-intention studies have focused on broadly common intentions like exercising more, eating healthier, or saving more for retirement. Why do people resolve to work out more and then stop going to the gym in February? People might find working out to be isolating and boring. Why do people purchase so many desserts in a cafeteria? If the desserts are positioned right by the cash register, then there is a reduced barrier to purchasing them. Why don’t people save more for their retirements? Simply needing to opt-in to retirement plans is sufficient to seriously reduce saving rates. These root-cause explorations can inform the design of new experiments to test the efficacy of design interventions.
Figure 3: A common gap between intention and action. [4]
In human factors validation studies, we design the studies to represent the environment for decision making as closely as possible. The use environment is set up to resemble the intended use environment. Devices with fully developed and functioning user interfaces are provided. Users with representative attributes are recruited – including representative conditions, backgrounds, experiences, education, and more. Realistic use scenarios are constructed to paint the picture of the full context of use. Then, with this simulated environment set up, we observe the behaviors and decisions of the participants. When we observe potentially harmful behaviors, real learnings only come after exploring the perceptions, assumptions, and attitudes of the participants as they respond to the design of their environments. Interviewing participants about their perception of the underlying root causes of use errors then helps identify the gaps between intention and behavior, and subsequently inform design modifications to enable future users to better align their actions with their intentions to deliver safe and effective treatment.
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References:
[1] Baron, J. (2008). Thinking and deciding (4th ed.). Cambridge University Press.
[2] https://www.actsafe.ca/epipen-performing-arts-fact-sheet/
[3] Koh, S. H., You, Y., Kim, J. S., Lee, D. C., Roh, S. Y., Lee, K. J., & Hong, M. K. (2019). Epinephrine-induced digital vasospasm reversed by a phentolamine-papaverine-alprostadil complex: A case report. Archives of Hand and Microsurgery, 24(4), 345. https://doi.org/10.12790/ahm.2019.24.4.345
[4] https://imgflip.com/i/2q6o6f