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Understanding the Cognitive Impact of Circadian Disruption: Designing for Shift Workers in a Healthcare Setting
Introduction
In the fast-paced and high-stakes world of healthcare, every decision can have life-altering consequences. Healthcare professionals, often working irregular hours, are particularly vulnerable to disruptions in their circadian rhythms—the natural, internal process that regulates the sleep-wake cycle. Even with adequate sleep, misalignment of these rhythms can significantly impair cognitive function, decision-making abilities, and error prevention skills. Recognizing these challenges, our research delves into the cognitive effects of shift work and circadian disruption, aiming to enhance the standard of care through improved understanding and innovative solutions.
Objectives
Our research is driven by two primary objectives:
- Investigating Cognitive Function Across the Day: We will conduct a comprehensive study to analyze how cognitive processing varies throughout the day for non-shift workers. By employing a rigorous, theory-based methodology, we aim to create a detailed profile of cognitive performance influenced by natural circadian rhythms. This baseline data will then be compared with that of night-shift workers to identify specific impacts of circadian disruption.
- Exploring Technological Interventions: In addition to understanding cognitive fluctuations, we aim to explore how technology can either exacerbate or alleviate the negative effects of shift work. Our goal is to design human-centric, accommodating interfaces that serve as cognitive support systems, ultimately reducing error rates and enhancing decision-making quality in healthcare settings.
People
This project is being developed by Dr Diego Garaialde, with Prof Anna Cox and Dr David Coyle (UCD).
Gendered Mental Load and Smart Technology in the family home
There is a long history of labour saving technologies in the home to reduce the amount of effort exerted on household chores. However research shows that much of the labour performed in the home is cognitive and emotional and is often hidden from society and also from the design of technologies. This type of work is referred to as family management labour.
Whilst existing psychology research has explored these forms of mental labour, there is very little research that links mental labour management and technology in this context as HCI research to understand the role of technology in managing mental labour has usually focussed on paid work rather than work carried out in the home.
The aim of this project is to investigate the mental labours experienced by family managers in the home. We aim to both broaden the understanding of these labours and explore the potential of technology interventions to support this often hidden type of labour.
People
This project is being delivered by Sarah Frampton under the supervision of Prof Anna Cox and Dr Sandy Gould.
Publications
Using digital games to recover from daily work strain
Digital games have been demonstrated to promote recovery from daily work strain. However, prior research has not examined the role that player experience (PX) plays in post-work recovery despite the fact that theories in this area rely implicitly on PX concepts. Hence, this research seeks to understand how the experience of immersion shapes the recovery potential of digital games. Our results suggest that immersion is broadly beneficial for recovery, though this is contingent on contextual factors, and that players actively optimise their immersion levels to maximise recovery. These findings extend previous research by empirically testing the PX-based mechanisms by which games are assumed to promote recovery, as well as offering design implications for creators of serious games for recovery purposes.
People
This project is being conducted by Jon Mella under the supervision of Prof Anna Cox, and Dr Jo Iacovides.
Publications
Mella, J., Iacovides, I., & Cox, A. (2024). ‘Jumping Out from the Pressure of Work and into the Game’: Curating Immersive Digital Game Experiences for Post-Work Recovery. ACM Games: Research and Practice.
Mella, J., Iacovides, I., & Cox, A. L. (2023, April). Gaming for post-work recovery: The role of immersion. In Proceedings of the 2023 CHI Conference on Human Factors in Computing Systems (pp. 1-15).
Mella, J. (2022). Investigating the Impact of Digital Game Immersion on Post-Work Recovery. In Extended Abstracts of the 2022 Annual Symposium on Computer-Human Interaction in Play (pp. 381-383).
Collins, E., Cox, A., Wilcock, C., & Sethu-Jones, G. (2019). Digital games and mindfulness apps: comparison of effects on post work recovery. JMIR mental health, 6 (7), e12853.
Collins, E., & Cox, A. L. (2014). Switch on to games: Can digital games aid post-work recovery? International Journal of Human-Computer Studies, 72 (8-9), 654-662.
eWork Radio
Register to use the eWork Radio app!
Read about how we developed the eWork Radio browser application
Nearly 500 participants contributed to our research on remote working
In spring 2020, an unprecedented number of people suddenly moved to remote working, many of them with little to no previous experience of working from home. This happened as a result of the nationwide lockdown restrictions taking place in many countries, in response to the Covid-19 pandemic.
From the early days of these lockdowns, we studied that impact that the shift to home-working has had on people who previously worked in offices. So far, we have surveyed nearly 500 participants from the UK and beyond, and provided them with personalised work-life-balance recommendations. We also conducted follow-up interviews with 25 respondents.
This data collection exercise allowed us to achieve an in-depth understanding of the problems that new remote workers are faced with. Some of the most common included:
- A lack of distinction between work and personal time
- Back and neck pain and other physical problems due to increased sedentary time
- Loss of opportunity to relax, exercise and disconnect during the commute
- Working in long blocks of time, without the breaks that used to happen naturally while working in the office
- Loss of the many opportunities for physical activity during the workday, like going out to buy lunch or walking to a photocopier
In sum, we found that, rather than being more relaxed while working from home, many people worked longer hours, with few breaks. The situation was particularly challenging for those with caring responsibilities, who found themselves in an endless marathon of work tasks and home duties, with little to no rest.
Your responses helped us create eWork Remote Work Radio
Based on these findings, we set out to design an accessible online tool that could be widely used by home workers and help them take more breaks during their workdays. When working from home, away from one’s colleagues, it can be easy to forget to take breaks, or even to feel like we should always be online and available. However, taking breaks throughout the day is crucial not only for achieving a better work-life balance but also for physical health, as stepping away from the desk on a regular basis helps prevent excessive periods of sitting which can be associated with negative health outcomes.
This is why we created eWork Remote Work Radio – a browser app that uses music to help you balance periods of work and periods of rest. You can help us trial this app simply by creating an account and using the app when you work, for as long as you wish.
Read this FAQ to find out about the way the app works
People
A team of researchers developed this project: Professor Anna Cox, Dr Sandy Gould, Dr Joseph Newbold, Dr Marta Cecchinato, Dr Anna Rudnicka and Dave Cook.
BreakBOT: A Digital Emotion Regulation Chatbot
Students frequently use social media (SM) as a digital break from studying. Concerns have been raised that these breaks harm academic performance and wellbeing by acting as a form of procrastination. Counter evidence suggests they can also act as a form of recovery that positively supports performance and well-being. It is currently unclear how SM can be used as a healthy rather than unhealthy break.
This project takes a research-through design approach drawing on behavioural frameworks and an emotion-regulation perspective to investigate how SM can support students in taking healthy breaks from studying. Four studies were conducted.
Study 1 used qualitative methods to investigate what characterises a healthy and unhealthy social media break from a behavioural and emotion-regulation perspective.
Study 2 was a systematic review of past emotion-regulation literature to synthesise design guidelines for developing technologies supporting healthy SM breaks and reducing unhealthy ones.
Study 3 involved co-design workshops with undergraduates in ideating and developing a chatbot prototype (BreakBOT) that implements emotion-regulation design guidelines to support taking healthy SM breaks.
Study 4 used a mixed-methods approach to explore undergraduates’ experience using BreakBOT in-the-wild.
Together this work provides a set of contributions that advance our understanding of students’ SM break-taking behaviour and how we can design systems to support them in taking healthy rather than unhealthy breaks when studying.
People
This project was conducted by Elahi Hossain under the supervision of Prof Anna Cox, Prof Nadia Berthouze and Dr Greg Wadley.
Publications
Hossain, E., Wadley, G., Berthouze, N., & Cox, A. L. (2024). Social Media Breaks: An Opportunity for Recovery and Procrastination. Proceedings of the ACM on Human-Computer Interaction.
Hossain, E., Wadley, G., Berthouze, N., & Cox, A. (2022, April). Motivational and situational aspects of active and passive social media breaks may explain the difference between recovery and procrastination. In CHI Conference on Human Factors in Computing Systems Extended Abstracts (pp. 1-8).
eWorkLife: Remote Working during COVID19 lockdowns
eWorkLife was a project that ran from 2020 in response to the sudden switch to remote working that was brought about by the COVID-19 pandemic.
We designed a self-reflection tool which aimed to help workers understand their remote working needs and provided personalised recommendations. This tool took the form of a brief survey, which included some open self-reflection questions and some validated surveys that were used to both help workers reflect on their work practices and provide recommendations to strategies they could adopt to help them adapt.
Our 3 step process
- Before you start, take some time to reflect on your work-life balance and what is it exactly you would like to improve. You can spend as much time as you want on this activity. Don’t know where to start? Click here to take part in our research project – we will guide you through a self-reflection exercise (10 mins) and provide you with guidance as to which strategies are most likely to work for you
- Select one or two strategies to start with and see how you get on. Remember, your time = your rules. If something doesn’t work for you, you can always revert back to old habits or try out new strategies. Click here to find an overview of the evidence-based strategies that can help you stay productive while working from home
- We know from psychological research that goal setting is really important in terms of changing a behaviour. A bit like setting an objective, it’s important to choose a clear and measurable goal. In order to help you stick to your new goal, we recommend you write down what you intend to try. You can also decide to share your commitment on social media, or just by talking to friends, family and/or colleagues. Keeping track of how are you going, and what is working, or not working is really important. Also, you will find that as time goes by, or situations change, you might want to revisit your strategies. Don’t be hard on yourself if you don’t achieve your goal. If that happens, set a more realistic goal and start again. It’s best to set small achievable goals than lots of different ones. Most importantly, make sure you give yourself a reward when you have achieved your goal! Those taking part in our research project receive additional support with setting goals to change their digital behaviours.
We have carefully chosen the examples of apps that are listed on this site and we hope you find them beneficial, however, unfortunately, we cannot be responsible for the information provided on other websites or in the apps listed.
- Index of Strategies
- Video content describing the strategies
- The science behind these strategies
- Feedback from people who have used our recommendations
Physical Activity during Lockdown
We were interested in how much physical activity people were engaging in – after the move to remote working erased the need to commute, the gyms closed and, for a period of time, even going out to exercise outside was only allowed once per day. We also wanted to understand the role of digital technology in helping people stay active during the lockdown.
We created a Physical Activity survey that was distributed on social media and through newsletters at University College London. The initial survey attracted a total of 390 participants who told us about their physical activity habits: how much time they spent exercising, commuting and sitting – before and during the lockdown and at the start of the survey, in May 2020.
We then sent out four weekly follow-up surveys, so that each week participants could tell us about the changes in their physical activity as well as their motivations and experiences of using technologies aimed to support activity, such as apps, online classes or step trackers. A total of 126 participants completed all five surveys.
We found that people who used digital activity trackers during lockdown demonstrated an increase in vigorous physical activity. This suggests that a robust exercise regime can be maintained even when access to gyms and classes is restricted and using digital activity trackers may facilitate it. On the other hand, we did not find the use of technology to be related with levels of sedentariness during lockdown. Moreover, although many people became more aware of the importance of physical activity during lockdown, problems with motivation and injury resulting from rapid changes in exercise routine, posed a challenge to staying physical active.
People
A team of researchers developed this project: Professor Anna Cox, Dr Sandy Gould, Dr Joseph Newbold, Dr Marta Cecchinato, Dr Anna Rudnicka and Dave Cook.
Publications
Rudnicka, A., Newbold, J., Cook, D., Cecchinato, M., Gould, S., & Cox, A.L. (2020). Eworklife: Developing effective strategies for remote working during the COVID-19 pandemic.
Newbold, J. W., Rudnicka, A., & Cox, A.L. (2021). Staying active while staying home: The use of physical activity technologies during life disruptions. Frontiers in Digital Health, 3, 753115.
Newbold, J. W., Rudnicka, A., Cook, D., Cecchinato, M. E., Gould, S. J., & Cox, A. L. (2022). The new normals of work: a framework for understanding responses to disruptions created by new futures of work. Human–Computer Interaction, 37(6), 508-531.
Gould, S. J., Rudnicka, A., Cook, D., Cecchinato, M. E., Newbold, J. W., & Cox, A. L. (2023). Remote work, work measurement and the state of work research in human-centred computing. Interacting with Computers, 35(5), 725-734.
Adolescent Mental Health and Development in the Digital World
In 2020, many university programs had to shift at least part of their teaching online. This opened up many questions about the impact of online learning and the lack of in-person interaction on students’ ability to learn and socialise and on their mental health. Professor Anna Cox and Professor Yvonne Rogers led a study investigating the the role of digital technology in the academic and personal lives of undergraduate students who started their courses in autumn 2020.
The study combined mixed-methods surveys with focus groups, conducted in November 2020, and involving a total of 38 student participants. The overarching aim was to understand how these students made use of technology to support themselves through starting university, in the context of the Covid-19 pandemic.
Each focus group participated in four half-hour discussions, centred around the following themes: (1) use of technology to improve mental wellbeing; (2) impact of social media during Covid-19; (3) impact of technology on students’ self-regulated learning strategies; and (4) challenges to maintaining focus during online lectures and strategies adopted to overcome them.
The participants reported using a number of technologies to support learning, social interaction and mental wellbeing. With lectures moved online, students appreciated being able to learn in their own time and at their own speed, however they also reported challenges around effective scheduling and motivation. Online lectures that involved polls and quizzes worked well at maintaining engagement. However, the use of different platforms and technologies across different modules created confusion and made it hard for students to figure out a timetable.
We also learned that some students shifted academic conversations to social media channels such as Instagram, as that was seen as a more reliable way of reaching people. Creation of breakout rooms during lectures was not always effective at facilitating social interaction, as some students struggled with starting a conversation, let alone making new friends. Messenger and social media groups organised by universities were seen as helpful at facilitating interaction between students, but were not available to everyone.
Moreover, the students reported that listening to music helped manage negative emotions and lift mood, and playing video games could help flatmates get to know each other. Other forms of online leisure, however, such as watching films, were often seen as a way of procrastinating, and associated with guilt, unless used sparingly.
This project was funded by the UKRI as part of the Adolescent Mental Health and Development in the Digital World project.
People
This project was led by Prof Anna Cox and Prof Yvonne Rogers with assistance from Elahi Hossain.
Publications
Hossain, E., Cox, A. L., Dowthwaite, A., & Rogers, Y. (2024). Adaptive, Sociable and Ready for Anything: Undergraduate Students Are Resilient When Faced with Technological Change. Proceedings of the ACM on Human-Computer Interaction, 8(CSCW1), 1-32.
Conceptualising and measuring digital emotion regulation
This project aims to develop a theoretical framework and novel technologies to investigate how, where, when and why people engage in digital emotion regulation. Existing research shows that individuals often use digital technologies to shape their emotions in response to situations; yet social norms often cast such technology use as disrespectful or distracting. The discrepancy between the practice and perception of digital emotion regulation is due to the lack of a systematic understanding of these practices. This project aims to develop a novel framework for better understanding digital emotion regulation, ways to study it in everyday settings, and evidence-based recommendations for managing it in ways that benefit individuals and society.
The evidence provided by this project will inform the societal debate about technology overuse and its impact on work, education and interpersonal relationships. The created knowledge will inform policy-makers, designers, and end-users about appropriate use of technology in everyday settings.
Find out more at the project webpage hosted at the University of Melbourne
Publications
Tag, B., Sarsenbayeva, Z., Cox, A. L., Wadley, G., Goncalves, J., & Kostakos, V. (2022). Emotion Trajectories in Smartphone Use: Towards recognizing emotion regulation in-the-wild. International Journal of Human-Computer Studies. https://doi.org/10.1016/j.ijhcs.2022.102872.
Wadley, G., Kostakos, V., Koval, P., Smith, W., Webber, S., Cox, A., Gross, J., Höök, K., Mandryk, R. & Slovák, P. (2022) The Future of Emotion in Human-Computer Interaction . CHI ’22 Extended Abstracts
Hossain, E., Wadley, G., Berthouze, N., & Cox, A. (2022) Motivational and Situational Aspects of Active and Passive Social Media Breaks May Explain the Difference Between Recovery and Procrastination . Proceedings of CHI 2022 Late-Breaking Work
iWARDS
With her colleagues in the Research Department for Medical Education (RDME) at UCL Medical School, Dr Antonia Rich recently interviewed 96 trainees who told them the many challenges to work-life balance they face. The study, “You can’t be a person, and a doctor” (Rich et al., 2016), was published in BMJ Open: https://tinyurl.com/Richetal2016.
They found that a lack of work-life balance in postgraduate medical training negatively impacted trainees’ learning and well-being. The expectation to prioritise work at the cost of their personal lives resulted in low morale and harmed well-being.
To help address this, Prof Anna Cox and Dr Antonia Rich developed an intervention to improve junior doctors’ well-being. In March and April 2018 we ran a series of free workshops with postgraduate medical trainees in three hospitals: the Royal Free, Whittington and University College Hospital. At the workshops, we explored how to enhance resilience and improve well-being. The first part of the workshop looked at how we can increase our resilience through self-care, and the second part of the workshop looked at how creating microboundaries can support work-life balance. Using “reflection cards” we prompted discussions in which participants reflected on and shared their own experience of the practical issues they face.
- Visit the iWARDS website
- Rich, A., Aly, A., Cecchinato, M. E., Lascau, L., Baker, M., Viney, R., & Cox, A. L. (2020). Evaluation of a novel intervention to reduce burnout in doctors-in-training using self-care and digital wellbeing strategies: a mixed-methods pilot. BMC Medical Education, 20(1), 1-11.
The temporal flexibility of crowdwork
Over the past decade, there has been a rise in the number of people working on crowdsourcing platforms. Although those who work on crowdworking platforms (i.e., crowdworkers) value having autonomy over scheduling their own time, research suggests that they do not benefit from the temporal flexibility to choose when and for how long to work. Therefore, in this project, we aim to understand what limits the temporal flexibility of crowdworkers, and how this aspect impacts the workers. Our ultimate goal is to inform the design of future crowdsourcing platforms.
We employ Value Sensitive Design (VSD) as our theory and design framework. Using the lens of VSD and a combination of qualitative and quantitative methods, we show that crowdworkers’ temporal flexibility is limited by three different types of time constraints: (i) worker-imposed time constraints, (ii) client-imposed time constraints, and (iii) platform-imposed time constraints. These time constraints limit: (a) the temporal working preferences of workers, (b) the time workers have to make decisions, and (c) the work pace and work schedules of workers. Ultimately, we confirm that the existing features of crowdsourcing platforms do not fully support flexible temporal arrangements for workers; instead, these platforms favour clients’ flexibility to workers’ detriment.
People
This project was conducted by Dr Laura Lascau under the supervision of Prof Anna Cox, Prof Duncan Brumby and Dr Sandy Gould.
Publications
Lascău, L., Brumby, D. P., Gould, S. J., & Cox, A. L. (2024). “Sometimes It’s Like Putting the Track in Front of the Rushing Train”: Having to Be ‘On Call’for Work Limits the Temporal Flexibility of Crowdworkers. ACM Transactions on Computer-Human Interaction, 31(2), 1-45.
Lascau, L. (2023). Time as currency: a value sensitive design exploration of crowdworkers’ temporal flexibility (Doctoral dissertation, UCL (University College London)).
Lascau, L., Gould, S. J., Brumby, D. P., & Cox, A. L. (2022, April). Crowdworkers’ temporal flexibility is being traded for the convenience of requesters through 19 ‘invisible mechanisms’ employed by crowdworking platforms: A comparative analysis study of nine platforms. In CHI Conference on Human Factors in Computing Systems Extended Abstracts (pp. 1-8).
Lascau, L., Gould, S. J., Cox, A. L., Karmannaya, E., & Brumby, D. P. (2019, May). Monotasking or multitasking: Designing for crowdworkers’ preferences. In Proceedings of the 2019 CHI conference on human factors in computing systems (pp. 1-14).
