Working with Urban Underserved Asthmatics

Some of Huyson’s sketches for some Aeris game concepts. Another fancy camera picture by Jessica.

We’ve always had a close relationship with UCSF, rooting back to the days when I was just a grad student there. Since then, KNOX has entered a formal collaboration with the university, completed a 66 subject validation study to verify Aeris’ accuracy back in June, and as of last week, we’ve had 167 people try Aeris in our most recent study!

While taking an entrepreneurship class 3 years ago, we had the chance to visit the asthma clinic at the Zuckerberg San Francisco General Hospital (ZSFGH). A few months ago, Philip Chung, a UCSF med student, approached us with an opportunity to pilot Aeris with urban underserved kids at ZSFGH. We supplied him with a couple of Aeris devices and our app, and he handed the rest.

Asthma is mainly prevalent in kids ages 5–17 in California. Slide created by Philip Chung.

Not only does California have a higher pediatric incidence rate than the national average, with 1 in 8 kids being affected, but most ER visits in San Francisco are due to children.

Slide created by Philip Chung.

Kids under 4 were excluded, since spirometry is not recommended for children below that age. During their regularly scheduled asthma clinic visit, families were asked to see if they’re like to try using Aeris. During this quick 5–10 minute session, a child played with Aeris. This was followed by 4 questions directed at either the child or parent.

When children were asked “What did you like?”

“The catching fish in the balloon game and blasting off”
“Going to far away destinations and learning about them”

What parents liked:

“You can use it at home and I have access to everything on my phone”
“It is kid friendly and keeps my child engaged”
“Easy to use — anyone can do it”

Yay, people like it! However, we also wanted to hear their criticism.

We then asked kids “What did you not like? Did anything confuse you?”

“Mostly nothing”
“How hard you have to breathe to control the balloon”

Our response: Got it, we’ll work on that.

Parents had a different opinion about their dislikes and confusions:

“Mostly nothing”
“I am not sure if she learned how to do spirometry well or if she is just not feeling well”

Our action: Tutorial videos have been refined and are being tested now!

We asked kids “What do you understand about the lung measurement?”

“Higher number is better”
“Lower number means I’m not breathing well”

Seems like these kids got it down!

Their parents seemed a bit more confused regarding the measurement:

“Higher number is better, but I don’t understand the spirometry graph”
“I need someone to explain the measurement to me and tell me at what number I should take my child to the hospital”

We reacted by creating a more visual way to understand these measurements, then went out to test it with families.

Going through some data visualization wireframes with Jason. Stealthily taken from my iPhone 6S.

Our last question to these kids was “Would you use this everyday to track your lung health?”

“Game is quick, fun, and I want to beat my high score”
“I would use this in morning and night to check my lungs and see if medicine is working”
“I would take this to school with me so I can measure how strong my lungs are when I don’t feel well”

Parents had differing views regarding whether or not they would use it everyday to track their child’s lung health:

Some parents: “I would only use this if there are symptoms or asthma is severe to track at home”
Others: “Measure everyday to compare against his best and know if he might need more medicine today”

We’re definitely not perfect yet, but we’re glad that we could get Aeris into even more people’s hands, so that we can continue building it in a way that will be useful to everyone in need.