6 Key Design Decisions Behind Kara, Our Product For People With Cancer

We’ve just launched Kara. Made in partnership with the Integrative Oncology team at the University of Pittsburgh Medical Center (UPMC) CancerCenter, Kara was made to support people with cancer by giving them a range of simple tools from the world of mindfulness-based meditation. This has been a lovely project to be involved with and here we wanted to share some of the thinking behind why Kara is like it is. So here are six key decisions we made through the design process.

#1. How We Decided Which Meditations To Include

There are two types of guided audio meditation within Kara. We call these the four core meditation tracks and the eight contextual meditation tracks.

As part of our initial conversations with the Integrative Oncology team, we became interested in which of the qualities that mindfulness training can help develop were the most important for cancer patients. The main four that emerged from this exploration were:

• kindness to oneself and to others
• self-awareness
• the ability to rest when you need to rest and
• the ability to allow things to be as they are even if they are difficult.

When we looked at the one-word versions of these qualities: kindness, awareness, rest and allowing we noticed that they spelt out Kara and it was too great of a coincidence that we realised it would make the ideal name for the project. These became the core qualities which anyone dealing with cancer would benefit from developing in themselves. Another way of thinking of these core tracks are that they are developmental i.e. by our developing these qualities, when we are moments of real need our baseline levels of kindness, awareness, rest and allowing have been improved and we are therefore more likely to be more ok than we might otherwise have been.

Meditation and mindfulness is historically always been a developmental practice. But here at Mindfulness Everywhere, we place a lot of emphasis on what we call real-time practice i.e. practising a technique ideally matched for a particular situation or mind-state. This is where the eight contextual tracks come in. Again, talking with Dr Lanie Francis and her colleagues at UPMC, we worked out what are the most common challenging emotions and mindstates that people affected by cancer faced and then designed practices best suited for them. These mindstates include ‘I am afraid’, ‘I feel overwhelmed’ and ‘I am a burden’. And we deliberately labelled them in the first person to better connect with the sense of their immediacy. So that is why the twelve tracks in Kara are what they are.

We had actually started the process thinking of mapping the meditations to particular parts of the patient journey e.g. a meditation for after receiving a diagnosis, a meditation for when you are receiving chemotherapy etc. However we quickly realised that this was far too medicalised an approach and would be highly alienating and no way near as inclusive as we hoped to be.

2. The Inclusion of Written Reflections

Most meditation apps only have guided audio meditations as their primary type of content but in Kara we have also included what we call Reflections. These are relatively short pieces of text, each of which outline a key mindfulness principle or mechanic related to dealing with difficult emotion or long-term conditions. The decision to include these happened during the project when I started to receive feedback from the UK edition of my book. What I found out was that people who had used our main app buddhify were getting additional value from reading the book and the reading was deepening their understanding and locking in some insights that the app alone was not quite doing.

In a guided meditation it is not necessarily appropriate to include a lot of ideas and explain mechanics since most people are only after a direct experience. But what the affordances of the book allows you to do is to present more of the underlying principles, models, concepts and mechanics of how and why mindfulness works. Therefore by combining the guided practices together with the reflections, Kara allows a more rounded learning experience. The reflections are also experienced in a very different style and pace to listening to guided meditations and therefore makes Kara a more diverse product.

3. The Inclusion of Real Stories of People with Cancer

Similar to the Reflect section, the Stories in Kara provide a different mode of content but they are much more than that. When I first made buddhify I never realised how much the app could be used by people in some of the most intense periods of their life. I’ve received so many emails from people who’ve used buddhify to help them with illness and so through the mailing list we invited people who had experience of using mindfulness in their cancer context to be interviewed about it.

My colleague Emmie conducted the interviews and so it was only when in the final site that I read them myself and they blew me away. They are for me, the most powerful part of Kara since they show what the reality of how the tools of mindfulness training can help at such incredibly challenging times. They also further personalise Kara, intended to help users feel hope and see themselves. At the moment Kara isn’t technically a social product but the Stories and the importance of peer-to-peer support in cancer communities hint at a direction any future social aspect may take.

4. Kara is a website, not an app

This is important. Despite being best known for apps, we wanted the barriers to discovery and usage of Kara to be as low as possible. First and foremost Kara was made so that Dr Francis and her team could give the patients at UPMC something they could start using by themselves be that at home, at hospital or anywhere. So we could have made it as an app but it soon became clear that making Kara as a site accessible through the browser but optimised for mobile devices was actually the natural choice since it meant immediate access and anyone around the world might find it organically through web search as well as being directly pointed to it.

The downside to Kara being a site is that it requires internet access at time of use since the meditation tracks have to stream rather being already on your device. This felt ok as a trade-off since we also included the option for users to download all the mp3 meditations directly so they can have them if they really want them. Another nice advantage to the site is that all updates can happen instantly…which is quite refreshing as someone who has had to deal with long AppStore approval processes in the past!

5. Kara is not just for people with cancer

This is perhaps less obvious but Kara is not just for people with cancer. And I mean that in two ways. Firstly the people affected by cancer are not just those with the illness. It is the family, the friends, the colleagues, the partners, even the clinicians. These people experience many of the same emotional states and could benefit from both the developmental and the real-time practices. We even know many people who have listened to meditations together and that can be a lovely experience to share.

The second meaning of Kara not just being for people with cancer is that other than the stories, the content doesn’t actually reference cancer at all. Therefore Kara can just as easily be used by anyone with dealing with any kind of illness or who is experiencing the difficult emotions referenced.

6. Kara is simple

We have made Kara as a beautifully formed but modest product. We wanted it to be easy to use and given how complicated the users life will be when they use it, exude a simplicity which is in itself refreshing. We have only just launched and so we will give Kara several months to settle in and listen to feedback. So there is absolutely scope that we will develop Kara further but if we do, we will still look to ensure simplicity is central to its interaction.

You can check out Kara for yourself at www.thisiskara.com

We’d love to know what you think and if you can think of anyone who would benefit from it please do share.

Rohan Gunatillake is the director of Mindfulness Everywhere, a creative studio combining meditation, design and technology. His products to date include buddhify, Sleepfulness, Cards for Mindfulness and now Kara. His first book is already out in the UK and is published in the US in January under the title Modern Mindfulness and is available for pre-order now.