Behind the PhD: Bianca Serban on designing health technology that fits in real life

Millions of patients are asked to track their health from home, yet many stop using these tools along the way. On 6 May, Bianca Serban defended her PhD at JADS, asking a simple but urgent question: what happens when technology ignores the reality of people’s lives? Drawing on patient stories, she shows how recovery is shaped by routines, emotions, and relationships, and why monitoring only works when it fits that complexity.

Why did you choose this research subject and what makes it so fascinating?

Before my PhD I had worked in a medical technology start-up, and although I had not given much thought about this topic before getting that job, it immediately fascinated me. The idea that you can design with technology to help someone who is in a vulnerable position, probably in the most difficult time of their life gives you a bigger purpose than “I will design cool stuff!”.

Monitoring lifestyle and health behaviours, especially, are a fascinating topic because there can be no right way to do it: physical activity can be measured in steps, minutes of movement, but also just subjective input of activity like “I worked in the garden” – for someone going through cancer treatment weeding the garden can be an amazing step towards keeping active on a bad day, while for a marathon athlete it can feel like a disappointment in their own capabilities. The question is: how do you gather, visualize and use health behaviour data in such a way that the person with a clinical condition feels good about themselves, their progress, and the clinician also finds it useful for their medical work?

Which challenges did you meet along the way and how did you overcome them?

One challenge was about the work itself – working with people and understanding how they use technologies is complex, subjective and also difficult to create research insights and generalize from. You have to be creative in your methodologies and data analysis process.

Another was the nature of my work: a human-computer interaction researcher. It is still quite a young role in a young field, compared to more established scientific disciplines. Explaining what I do and how my work is useful when working in multidisciplinary teams with technologists, biochemistry scientists and so on was sometimes intimidating and difficult, but eventually successful and satisfying. My role and work helped the project deliver more valuable technologies that could function in real-world conditions.

What is the impact of your work in the real world?

Firstly, lifestyle telemonitoring systems have to be used for longer periods of time in order to be successful. For instance, a patient needs to wear the smart watch or on-body patch correctly for it to collect data properly, and use a self-reporting mobile application to give feedback to the clinician on how they feel or what they did every day. In order for these mechanisms to be successful, such technologies need to be comfortable, convenient and engaging to be used – something which cannot be possible without understanding the lives in which they are placed first so their fit properly and are not a burden.

Secondly, as the European Union tightens its regulations around medical devices, most notably through the Medical Device Regulation (MDR 2017/745), which now explicitly requires manufacturers to demonstrate usability and human factors evidence as part of device approval – the kind of contextual, patient-centred knowledge this research produces is becoming not just good practice, but a regulatory necessity. A device that patients abandon, misuse, or find too burdensome to integrate into daily life is, by definition, not a safe or effective device. This research provides the frameworks and methods that designers, clinicians, and developers need to meet that standard – and to do so in a way that genuinely serves patients, rather than simply satisfying a checklist.

What are your plans after your PhD?

I would like to work more at the intersection of Human-Centric Design research and this regulatory angle in medical technologies. I would first like to understand how it is currently done in industry – how standards are engaged in the design process, what are the current steps a company takes when designing a medical technology that involves patients and clinicians. For the further future, I would like to influence such policies and medical device regulations so that usability, and human factors will be as important as clinical accuracy.