Contextual inquiry
How to use a contextual inquiry when developing your digital health product.
When conducting research, we often ask people questions (for example, in a survey) about what they usually do and have done in the past. However, human memory can be unreliable.
A study designed using contextual inquiry tries to overcome this issue by observing people in their context while inquiring (observing and questioning). This helps the researcher gain a comprehensive understanding of what users do in their environment.
What to use it for
Use contextual inquiry to:
- inform product or service development (formative or iterative evaluation)
- develop a new feature for your digital product
Similar to ethnographic studies, contextual inquiry investigates how your potential users interact with their natural environment rather than just focusing on your digital product. Contextual inquiry involves in-depth granular exploration of a small sample of people.
Pros
Benefits of contextual inquiry include:
- it can provide a nuanced and rich understanding of how and why people engage with their environment, factors that are often not reported
- it reduces recall problems – when results are distorted by the fact that people use their memory when removed from their environment
- it is usually conducted with a small number of participants
Cons
Drawbacks of contextual inquiry include:
- contextual inquiry is not intended to tell you if your digital product is effective
- it can be subjective, as it is very dependent on the researcher’s interpretation and skills
How to carry out contextual inquiry
Contextual inquiry uses a combination of observation and interviews. The length of a contextual inquiry can vary from an hour to several days, depending on participants’ availability and the complexity of the processes you are trying to understand. The 4 basic principles of planning and conducting contextual inquiry are:
1. Context
Conduct your study in the natural environment to understand the user in the real world. The influences of immediate physical environment, as well as psychological, historical, cultural and social factors, cannot be underestimated.
2. Focus
Be clear about your research aims and objectives and what you want to get out of the session.
3. Partnership
As mentioned in the previous point, knowing what you want to get out of the session is important. However, you should still be flexible and open. Participants should feel that they can direct the researcher towards what they consider to be important aspects of their life.
4. Interpretation
The outcome of contextual inquiry is a shared understanding of participant’s working or other practices. You achieve this by observing, enquiring and building an understanding of a participant’s world, checking with the participant by asking for clarification and confirmation until you build a comprehensive picture.
Understanding the context
Your goal as a researcher is to understand the participant and how different forces influence their actions, working practices and processes. These can be external forces, like their physical environments, their family or work colleagues, and the wider environment that impacts on what they do. Internal forces include their attitudes, values, knowledge, reasoning and motivation.
Through observing and interviewing, you may uncover what is often implicit or invisible but may be important for designing an intervention.
As with any research, start by making participants feel at ease, introduce yourself and explain what will happen. Discuss confidentiality, what they should expect and whether you plan to film or record their actions. Make sure to take notes.
Explain to the participant how the session will work:
- you will observe their actions, for example their work, in order to learn. Your role is to observe, learn and understand while they go about doing their tasks.
- you will sometimes interrupt them to ask for clarification and explanation
- they should let you know if you have interrupted at an inconvenient time and they would prefer to wait before answering the question (for example, they want to complete an action first)
When to interrupt to ask questions
You should interrupt the participant if:
- they do something you don’t immediately understand
- you think you understand their process but you want to confirm it with the participant
Be aware of your participant going into interview mode. It is important to guide them back to the task at hand as uninterrupted as possible.
Throughout the process, the researcher and the participant develop a shared interpretation of the work. At the end of the session, review your notes and present your understanding of the process you’ve been researching to the participant. They may clarify and correct your understanding of their working practices.
As with any qualitative data analysis, use a systematic approach to analyse the data, for example thematic analysis. The analysis can be subjective, so it is good practice for 2 researchers to conduct the analysis and compare results. You could assemble a multidisciplinary team to share the results, interpret what they mean and create actionable recommendations for design solutions.
Example: exploring interruptions and distractions while completing a task – a contextual inquiry
Borghouts and others (2020), TimeToFocus: Feedback on Interruption Durations Discourages Distractions and Shortens Interruptions
It is common to be interrupted while completing a task. This can be detrimental, for example, by:
- decreasing efficiency
- increasing mistakes
- inducing stress
Researchers aimed to understand more about how people deal with interruptions and distractions while working. They conducted a contextual inquiry with 9 office workers doing financial administration at public universities.
They chose a task that was frequent and common to all participants: data entry related to processing an expense claim. In fact, processing the claim often required disruptions as additional resources were often needed, either in physical or digital form. The sessions lasted from 2 to 2.5 hours and they were audio- and video-recorded.
Each session started with an interview. This helped the participant to feel at ease and helped the researchers to understand the participant’s job role and their strategies for coping with interruptions. Then, participants were asked to talk while they processed an expense claim, using think aloud (link). The researcher observed the participant while they were working. The researchers summarised the findings, asking for confirmation or clarification when needed. If any parts of the process needed further clarification, researchers consulted the video recording to aid shared and comprehensive understanding of the working practices.
Researchers found that, although participants try to prepare access to the additional resources that will help them to complete data entry for processing an expense claim, they often needed resources that they did not anticipate, both physical and digital. They then made a decision on the spot on whether they should interrupt the task to find more information or postpone the interruption till later.
Interestingly, interrupting a task to get additional digital resources was treated differently to interruptions to get physical resources. Participants seemed to be more likely to interrupt their task to retrieve digital resources. They often perceived that digital resources would be easier and faster to locate, but in fact, participants often took longer than they intended to locate them.
This contextual inquiry led to 3 main design implications that were used to design a digital product to help manage interruptions online.
More information and resources
Health Foundation (2014) for more information about how context matters when developing an intervention
GOV.UK user research blog describing an example of using contextual inquiry in practice
GOV.UK user research blog How we’re using contextual research to improve GOV.UK Notify
Viitanen (2011), Contextual Inquiry Method for User-Centred Clinical IT System Design
Examples of contextual inquiry in digital health
Herrmann and others (2017), Watts your usage? A field study of householders’ literacy for residential electricity data. Authors used contextual inquiry with think aloud to find out how users interpret the graphs of their electricity usage on a website.
Vanhoof and others (2018), Shedding light on an unknown reality in solid organ transplant patients’ self-management: A contextual inquiry study. In this contextual inquiry, the team explored how patients who received a transplant self-manage their health behaviours and medications. As part of their recommendations, they argue that digital self-management intervention can play an important role as an addition to face-to-face interactions.
Ho and others (2013), Needs and workflow assessment prior to implementation of a digital pathology infrastructure for the US Air Force Medical Service. An example of the use of contextual enquiry to identify the needs and requirements of pathologists with an aim to explore the potential to develop a digital pathology system.