With tablet computers, seniors flag problems in local neighborhoods

- By Kris Newby

Leslie Williamson description of photo

Feliciana Jimenez documents hazards in her neighborhood using a computer tablet.

Feliciana Jimenez, 80, squints with a critical eye at the camera window of a tablet computer. Through this lens, she sees her street in a whole new light.

She takes pictures of crumbling sidewalks and a construction worker's hose, coiled like a snake at her feet. She hits the record button on the tablet to describe how these hazards could cause seniors to trip and fall. She captures images of clogged sewer drains covered in stagnant water that could breed mosquitoes. As each hazard is recorded, the tablet saves its precise location on a map, using the device's built-in geographic positioning system.

Jimenez lives in the North Fair Oaks neighborhood of Redwood City, where she is fighting for a safer, healthier neighborhood. She has volunteered to test two new devices — a customized tablet computer and a wearable camera — both of which can be used to notify city planners about things that need to be fixed and improved, from hardscapes to landscapes.

The benefits of these changes in the "built environment" — the man-made structures that define a place — go well beyond aesthetics: People who live in places that promote walking, socializing and eating fresh foods are physically and mentally healthier than those who do not.

Abby King, PhD, professor of health research and policy and of medicine, developed the customized tablet for documenting neighborhood hazards. She and her team at the Stanford Prevention Research Center are now creating a social blueprint for teaching residents and grassroots organizations how to persuasively communicate these community needs to city planners.

Jimenez's street is lined with boxcar rows of post-war houses adorned with cast-iron grates on windows, brick fences and plaster lawn ornaments. Homes are mixed in with light industry — an auto repair shop, a welder and a cabinetmaker. Around the corner are small retail stores selling Mexican groceries, piñatas and quinceañera gowns in Easter-egg colors.

As Jimenez walks down her street, two Stanford researchers observe how she interacts with the tablet computer, looking for ways to improve it. Called the Stanford Healthy Neighborhood Discovery Tool, the simple-to-use tablet is loaded with software developed by King's team to track users' walking routes and geographically tag hazard locations, linking them with the users' audio narratives and photographs. Afterward, it leads the user through a questionnaire about the walk.

As Jimenez stops to snap pictures of graffiti and an overflowing trash bin, the two researchers — Sandra Jane Winter, PhD, a Stanford postdoctoral scholar, and Priscilla Padilla Romero, MPH, MPP, a community partner from San Mateo Medical Center — take a few moments to show her how to verbally record her impressions of each neighborhood feature.

After the walk, hazard images and location coordinates can be uploaded to an online map, which can be shared with researchers, city planners, policymakers or others involved in the project. The walking routes of all participants are overlaid on the map, making it easy to identify the most traveled routes, where repairs would make the biggest difference.

Jimenez also wears a Microsoft SenseCam camera around her neck; it automatically snaps a picture of everything in her field of vision every 12 seconds. Later these images will be analyzed using software developed by King's collaborators at the British Heart Foundation Health Promotion Research Group in Oxford, England. For the purposes of King's studies, the camera's built-in GPS function provides information on distances and walkability to food sources, jobs and local transportation. It also allows researchers to identify hazards that participants might have overlooked.

King's dream is that her tablet-based tool will provide a low-cost way for community advocates like Jimenez to work with city officials to improve their neighborhoods. But before King launches it into the world, she and her Healthy Aging Research & Technology Solutions team need to collect more evidence to not only improve the tool, but to teach community groups how to use it.

About a year ago, King and her team tested the precursor to the tablet within a population of 400 seniors in East Palo Alto. The study looked at ways to better inform city planners about the physical barriers to fresh-food sources. In February, the team celebrated its first success, after being contacted by Brent Butler, planning manager for East Palo Alto.

"Some of the street issues that this Stanford study brought to our attention have been added to our comprehensive sidewalk inventory and repair program," Butler said.

These suggestions were influential to the city's decision to add countdown timers to crosswalks on its main thoroughfare, University Avenue, to ensure that seniors and children allow enough time to cross. The study also helped the city document sidewalk obstacles that impede movement of people using wheelchairs, walkers and strollers.

Some of these future improvements may be funded by an unexpected patron: Mark Zuckerberg, founder and CEO of Facebook. In July 2011, Facebook employees moved to the neighborhood, into the former headquarters of Sun Microsystems, near the intersection of Willow Road and Bayfront Expressway. The company has pledged more than $800,000 annually to East Palo Alto and neighboring towns over the next 15 years to help improve traffic flow and create better pedestrian and bike paths.

This fortuitous collaboration with Facebook shows how valuable it is to have "shovel-ready" priorities documented when funding opportunities arise and how useful the discovery tool tablet can be for identifying those priorities.

To date, King and Winter, the postdoc, have collected data from 15 of the 40 volunteers anticipated to participate in the North Fair Oaks study, which is funded by the medical school's Office of Community Health by a seed grant from Spectrum, which oversees Stanford's National Institutes of Health Clinical and Translational Science Award.

Next, they will organize a community advocacy meeting to help the study participants prioritize neighborhood issues by importance to the community and feasibility of being addressed. Together, these residents will develop an action plan and present the ideas to local health policymakers.

"This phase of the study is important because it ensures that the community members, not outside researchers, are advocating for change within their own neighborhoods," Winter said.

About Stanford Medicine

Stanford Medicine is an integrated academic health system comprising the Stanford School of Medicine and adult and pediatric health care delivery systems. Together, they harness the full potential of biomedicine through collaborative research, education and clinical care for patients. For more information, please visit med.stanford.edu.

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