Application of UX and behavioural sciences in digital and non-digital health

The healthcare industry can learn from so many different disciplines if it takes the best bits and practices and use these to suit their needs to improve patient care

I have recently attended three separate events, each in disciplines that share a common goal: the creation of a great experience for their customers, whether these be information seeking members of the general public, retail consumers, patients, HCPs or anyone with an interest in their tool, product or website. First came the World Information Architecture (IA) Day 2017 in Manchester. IA is the discipline of organising and arranging information online in such a way that promotes and supports usability and findability of this information. The World IA Day is an annual event designed to bring together like-minded people to help shape the future of this field. Next came the 3rd Centre for Behaviour Change (CBC) Digital Health Conference in London, where academics and industry experts met to hear about some of the great behaviour change work that is being done around the world, particularly in the digital space. Finally, there was the latest Northern UX (NUX) meetup in Manchester, where Valtech and Transport for Greater Manchester (TfGM) gave a joint presentation about their research-based approach to updating the transport website for Greater Manchester, an exceedingly complex transport system.

I identified a number of common themes between the way these different organisations and disciplines approach their work but I want to pick out the three that I think are most important. I will also look at whether these are routinely implemented across the healthcare industry and if so, to what extent?

1. Keeping the customer as the focus

At the World IA Day 2017, Matt Jukes and Jonathan Porton gave an enlightening talk on their task to redesign the website for the Office of National Statistics (ONS), which was previously described by the Financial Times in the UK as “…a national embarrassment”. They spoke of how, despite its popularity in terms of site traffic, the website was described as “confusing” and difficult to navigate. For me, one quote that really emphasised the need to focus on the consumer was, “The ONS website makes me want to cry”. I think if there is one thing a website is not meant to do, it is make you cry when you are trying to navigate through it. The previous ONS website had clearly been built with no consideration of the end user. The only reason it was able to survive as long as it did was because the information on ONS could not be found anywhere else, meaning people had no other choice. Had this been a website with any sort of competition, it would surely have failed. By shifting the focus of the website to the user, instead of the organisation, Matt and Jonathan were able to make a consolidated, more user-friendly website. An example of keeping the customer as the focus from the Digital Health conference was a talk done by Hawys Tomos about their approach to creating gripAble, a device for hand rehabilitation in stroke patients. Stroke rehabilitation is a painstaking process for those that have to endure it, which can result in poor adherence to rehabilitation exercises as well as an impact on a patient’s mental health and motivation. Therefore, gripAble was created to address a clear need for their customer, i.e. the patient. In addition to addressing a clear need, the development of the product made no assumptions about what patients wanted and focused almost entirely on feedback from the patients themselves. As a result, they have created a fully functioning product that is well received and used by the patients who need it. Finally, at the NUX meet up, I listened to Carolyn Warbuton and Brian Austin talk about how they focused entirely on the needs, thoughts and opinions of all possible users across all parts of Greater Manchester when updating the TfGM website. This included speaking to people from all backgrounds in the region; race, gender, age, and ability. It was crucial for them to understand these perspectives and develop a unified approach to the website that would be welcomed by all.

Does the healthcare industry do this routinely?

It’s starting to more and more. “Patient-centricity” is a growing term with more pharmaceutical companies employing staff dedicated to the idea of keeping the patient at the centre of what they do. This is a great step in the right direction, however, when developing interventions or solutions to business or healthcare problems, it is crucial to understand who your customer actually is, whether patient, physician or payer. If you are creating an educational programme for HCPs, for example, then clearly you need to focus on the needs, opinions and thoughts of the HCPs. Keep them involved, engaged and make them feel valued in the process of developing such a programme. Without this knowledge and understanding of the end user, it will be more difficult to achieve full engagement once the product or intervention has been launched.

2. Customer focus thorough, in-depth research and testing as the foundation

Juls Hollidge, co-founder of Kore, gave a great presentation at the World IA Day about the need to identify, understand and then structure your product. She discussed how an intense look at a company and their specific problem, termed ‘research deconstruction’, will identify invaluable pieces of information that could eventually be the difference between a “good” product and a “great” product. The essence of the argument is that a truly detailed understanding of a product / situation / organisation will yield far greater insights, and subsequently results, than an approach that is created based on various pre-existing assumptions. Fast forward 4 days and I am hearing similar things at the CBC Digital Health Conference. One example specifically springs to mind, where Emilie Glazer at Ctrl Group spoke about their latest project, Dementia Citizens — a tool to help people with dementia and their families find new activities using technology and learn of ways of living with dementia. A strong feature of her presentation was their approach to the research, which was conducted in the real world and was participant-led, as well as their emphasis on co-creation with the end users. This approach meant there was a more iterative process applied to the development of the intervention, where patients and carers could provide feedback on different prototypes and make useful suggestions to make the app a worthwhile tool. In this example, without a true understanding of the needs of dementia patients and their carers and their opinions on a digital intervention, Dementia Citizens could have easily been created based on ill-considered perceptions of ‘what they thought people would want’. I have no doubt that if Ctrl Group had made such assumptions, Dementia Citizens would look very different to how it does today. Finally, this idea was further supported by Carolyn and Brian, who described the iterative approach they took when researching and testing hypotheses, prototypes and designs related to the TfGM website. They tested their prototypes with people all over Greater Manchester, making a point of ensuring they covered people from all walks of life. This further validated the outputs of their research. It also ensured that only fully tested and ‘user-approved’ ideas and designs were sent through to the development stage. Not only is this more effective, but it is more efficient. The most important lesson from these examples is that the time, money and overall investment in this slow, detailed process of information gathering and research might appear a little ‘overkill’ at first glance. However, one must remember the huge potential for more effective and lucrative product / intervention as a result of this initial investment. The effect this approach can have should not be understated.

Does the healthcare industry do this routinely?

Not quite. Budget and time restrictions are often barriers to this level of intense scrutiny, and while this may be a challenge, one must appreciate that a more superficial look at a problem will only yield superficial results from the solution. By using the theoretical domains framework (Cane et al, 2012) you can develop a robust foundation for a more in depth and meaningful look at what factors could be influencing a given behaviour. As human behaviour is at the core of everything we do, both inside and outside the healthcare industry, there is a great opportunity to take lessons from success in other industries, to delve deep and really get to grips with what the problem is before trying to develop solutions.

3. Use of behavioural science and psychological principles, either consciously and unconsciously

To a certain degree, many people end up using principles of behavioural science and psychology in their work unconsciously, particularly those that are more experienced and have seen what does and doesn’t work in an industry. However, as awareness and knowledge of behavioural sciences increases, people are starting to use these principles in a more deliberative manner. Either way, it’s a theme that runs through lots of industries, including digital. Stuart Curran from Thoughtworks spoke about the relationship between information architecture and writing comics. It was a very interesting talk but one bit I want to pull out in particular is his unstated reference to the ‘peak-end rule’. The ‘peak-end rule’ refers to the idea that people’s perception of an experience will be judged according to the peak moment of the experience and the end of the experience, rather than the total sum or average of each moment. Stuart introduced the talk by outlining the importance of understanding the whole user journey of any digital solution, specifically identifying the peaks and troughs. Stuart never used the term, ‘peak-end rule’, but there was a clear appreciation of this idea that people will judge an experience according to the “peaks” rather than the simply the whole experience. At the Digital Health conference, Edward Pogorskiy spoke about the development of a web extension designed to improve learners’ retention to online courses — DoUseful. He described how they utilised features of the Behaviour Change Techniques (BCT) Taxonomy — a great tool developed from academic theory for the creation of effective behaviour change interventions. More specifically, they ensured the web extension allowed for goal setting, action planning and feedback on behaviour, with a plan to explore the impact of other BCTs further in the future. In using this approach, they were able to make DoUseful a scientifically robust tool to enact behaviour change. Like with the World IA Day, there were no specific mentions of behavioural science at the NUX meet up. However, by its very nature, UX regularly employs behavioural science principles to encourage a certain behaviour, albeit generally unconsciously. By making things easy and simple for the user, you inevitably limit cognitive load, making it less likely that they will give up interacting with your site or product.

Does the healthcare industry do this routinely?

No. A recent survey, conducted among various pharmaceutical company employees, found that only 12% of those asked said they use elements of behavioural sciences in their work every day. As I mentioned previously, human behaviour is the core of everything we do. Therefore, neglecting to use the principles of behavioural science and psychology is neglecting the core element of the industry.

No matter what industry you work in, it is vitally important to look at the whole picture through in depth, meaningful research, considering the user or stakeholder of interest as the focus, and use the latest research and knowledge of behavioural science and psychology to address the biggest customer needs. There is also value in regularly monitoring the digital industry, whether you work in it or not, as it continues to grow at a remarkable rate with new ideas coming out daily. The healthcare industry in particular should be looking at the digital world with more interest, in order to develop effective products or interventions that will improve patient outcomes.