Into the Bowel of Preparation: A UX Design Challenge on Colonoscopy Preparation Guidance

I was given two weeks to work on an individual UX design challenge of our own choosing. A passion project, as they called it. What better suitable topic than one that I had spent six years immersed in — Endoscopy Nursing.

I wanted to start on a fresh topic such as patient information or management, but with research, it revealed itself to be too broad. So, I put my big girl pants on and chose a topic I felt I had failed on in my previous personal startup — colonoscopy preparation guidance. It had been close to two years since I first built the concept without knowing anything about the design process. I wanted to start fresh with this and see where the journey takes me.

Personal Project Notes

Challenge

Identify key pain points amongst patients undergoing colonoscopy and design a solution to better guide them through their planning and preparation phase.

A Colonoscopy is a medical procedure where a long, flexible, tubular instrument called the colonoscope is used to view the entire inner lining of the colon (large intestine) and the rectum.

Reported in 2011 by the Department of Health, Medicare provided reimbursement for around 3.4 million colonoscopies in Australia over the last decade. That’s just under the total population of Melbourne.

Studies suggest that the lack of access to health care and a lack of awareness in both young patients and their doctors are causing the higher incidence of colon cancer and rectal cancer in young adults under age 50. Most especially the lack of understanding about the signs and symptoms of colon and rectal cancers and the importance of a colonoscopy. (Fight Colorectal Cancer, 2017).

Getting to know the landscape

I began digging around for direct competitors who are using a form of technology to assist patients through their colonoscopy preparation. I also kept an eye out for indirect competitors who are integrating technology and patient advocacy in a meaningful way.

I gained one main insight from this exercise. Although the majority of the competitors I stumbled upon were mobile applications, those involving colonoscopy were outdated and had a weak user following.

Indirect competitors, such as Mango Health, Pregnancy+ and Kindara proved that there is a strong ability for technology in user’s health. It validated that technology can go through a health journey with users and create support, guidance and even rewards for positive behaviour.

Getting to know the people

Calling up different doctors and clinics on the first day of the challenge, I was able to get permission from the different levels of the clinic to interview on site. This was really important to me, as I wanted to ensure I had a solid foundation for my research when stepping forward.

In a span of two half-days, I was able to interview 14 patients — ranging from a gentleman in his late 20’s to a lovely grandmother in her early 70’s. They were coming in to see their gastroenterologist and if they had a spare moment or two, they would come and sit with me for a chat.

From observations, user interviews then to an affinity map, these are the key insights:

• Most users, after the initial doctor’s consult, do not have prior knowledge to the procedure and expectations.
• Planning and further research into procedure and preparation expectations are self-initiated.
• Users’ primary point of information are support systems:
  - family and friends who may have undergone the procedure previously.
  - those comfortable with technology will follow this with an online search.
• Complementary tools to assist with the preparation include: phone alarm, “Siri” and/or physical support (spouse, family, wall clock).

IDENTIFIED GAPS
Although instructions are clear and understandable, people are currently using complements to their preparation process to help them:
1.) further understand what to expect;
2.) reassure their own fears; and,
3.) complete each step accurately.

SOLUTION STATEMENT
Design a streamlined solution to contain all user needs for their colonoscopy and preparation.

Getting to know our users on a deeper level

Meet Mona — who finds joy in her garden and shares it at the market on the weekends along with her husband, Howard.

Mona gets a reminder in the mail about her colonoscopy screening and she then sees her doctor to book herself in. Previously, she had spoken to her friends who had gone through the procedure. During her preparation, Howard is her knight in shining armour. He makes the drinks for her, plans out the times for her, and calls out for her when it’s time to drink. She gets through the procedure and is left feeling good about the over-all experience.

Meet Kevin — married to his beautiful wife, Yuna, with a baby on the way.

Kevin experiences some concerning symptoms and sees a doctor about this. He’s referred to a specialist who then explains to him that he will need a colonoscopy. Through out the journey, there are many points of uncertainty, missing points of support and hesitations. He comes out relieved that the procedure is over and he can now focus on the diagnosis — things are always better in hindsight.

With a simple glimpse between the two customer journey maps, there are already main points of differences in regards to thoughts, feelings and doing.

The biggest take-away is that I was also then able to identify the medical motivator between the two user groups. Mona is coming in for bowel cancer screening. Kevin is coming in due to potential symptoms of inflammatory bowel disease.

I can now focus on a specific user group as I continue to design this solution.

How Might I & What If

After ideating through “how might we” and “what if,” I used a feature prioritisation axis (impact vs complexity) to help me logically score the different potentials for the solution. It had to cater to a user group that is comfortable with technology, help them understand what to expect, complete each step accurately and reassure their own fears.

From there, the features I wanted to prioritise within the initial prototype are:

• Calendar and Contacts integration
• Audio Feedback — Ping for notifications, Ring for alarms and actions
• Visual Guidance — Schedule and checklist, Information resource (FAQ and article format)
• Social Stories — Personal testimonials and tips

Why should I download this?

A feedback I also received in my ideating and sketching phase is that I had to offer some form of value before I could ask for users to give information or sign-up. This made complete sense. Who would want to sign-up for something or download a mobile application if they didn’t understand what the benefits are or what the purpose is?

With further ideating, research and sketching, I came upon this solution:

An iOS mobile application with OCR and key features

The Doctor Said So

For this solution to succeed, doctors would have to recommend this to their patients. This strategy would have to involve benefits for the clinic too which will be covered in future planning.

Apple vs Android

Apple’s iOS 11 currently include enhancements such as a built in QR reader. Android phones with Google Now on Tap still require additional steps. The use of a QR code to lead them straight into the App Store will make the mobile application one-step away instead of a fiddle through the App Store.

OCR

Optical character recognition (OCR) is a common method of digitising printed texts and is widely used as a form of information entry from printed paper data records. There are many mobile applications on the market that currently incorporate this into their platform. This would be the best way to remove the hindrance of users inputting their procedure details.

From a single sheet of A4 paper with instructions, users will walk away from a doctor’s consult with an A6 size sheet of paper with a QR code that links them to a platform of resources and a detail form completed by the doctor and receptionist to be scanned into the app.

Test on paper. Test on people.

From the journey map, I translated it into a simple user flow for the mobile application and started off on paper prototypes. Tested these on 4 individuals and gained the following key insights:

• Language & Information — The amount of information users wanted to see and the language used had to be clarified and changed. This was a good reminder that my medical background can lead me biased in regards to the words I use in the app.
• Notification Purposes — Testers shared that they already have many notifications from apps they currently use. They would rather have prompts that tell them what to do and important reminders for their procedure.
• Technology — This helped verify and further look into ways to reduce hindrance from downloading the app and using it too.

Putting it onto a screen and further testing with 4 different individuals, I got the following feedback:

• “What happens if I don’t complete a task at hand?” — I created further screens to show how steps are highlighted when overdue and the time adjustments that happen when it is finally completed
• “What happens after the procedure?” — I added further steps at the bottom of the calendar to show what is to be expected after the procedure. Also made reference to articles that will be available as a resource.
• “I think you have a small finger if you think I can click that” — I increased the size of the tick boxes. Yes, I do have small fingers.

Interactive Prototype

Here is my interactive prototype - click here.

Implementation plan & motions to the future

Fundamentally, the solution is a mobile application. But I foresee it to be a service that can be provided to patients, clinics and hospitals. And then, potentially, through strategic partnerships with organisations, become a norm within colonoscopy preparation.

Phase 1

• Further testing and iterations amongst users.
• iOS Development in collaboration with developers, visual designers, pilot clinic and patients.
• Potential: White-labelling — offering it to clinics and hospitals to rebrand the product as their own.

Phase 2

• Integrating further factors into scheduling — such as medications and medical history.
• Variety of information resource format — developing animations or videos, depending on user feedback to the best format of information.
• Potential: Administration Portal — design solution for clinic administration to be used in conjunction with the user’s mobile application for procedure management, storing and sharing reports, and such.

Phase 3

• International Language — translating the information into different languages (one at a time) to cater to user’s whom English is not their first language.
• Expansion — offering services to clinics, hospitals and potentially partner with organisations such as Crohn & Colitis Australia, IBD Support or Bowel Cancer Australia.
• Potential: Chatbot & Gamify — targeted towards the younger range of the user group by making it enjoyable and easy access to support.

Phase 4

• Diversifying — using the same foundation to cater to different medical procedure and potentially allowing one platform for user’s to prepare and store multiple procedures.

This is a solution that only touches the tip of the iceberg but I hope it can potentially be a tool to better the experience of people with IBD and colonoscopy in general.

Personal Insight

Going through a design challenge on your own is both exhilarating and scary. There’s no one else to share the load with and you need to be able to nail each step on the head to make sure you’re well set-up to succeed in your next move.

The solution I have come up with here is slightly similar to what was produced a year ago but I firmly believe that in its core, this solution has a stronger foundation to grow from. In the beginning, I was afraid that my fears and insecurities from my start-up would get in the way of being objective with this process. But, if anything, the process made sure that my emotions didn’t get in the way of producing a well-structured design. I ensured that in every decision I made, it had a strong basis from my research.

I guess at my very roots, I will always fall into healthcare but I derived my biggest joy from going through the design process and learning something new in each and every step.

A Little Bit about Me

I am a Melbourne-based User Experience Designer. Nurse and start-up founder in a parallel life. Naturally curious, inquisitive and empathetic towards things old and new. Learn more about me here.

Post-Publication Edits & Feedbacks

I have been receiving really helpful insight and feedbacks in regards to this project. Thank you!

Feedback#1: Creating a web-app with procedure information already integrated into the QR code.

Feedback#2: A direct SMS to patients to the app link.

Any more feedback or ideas? I would love to hear them!