Health & Wellness
Project Framing Presentation
Knowledge Acquisition
Written by Corina
Knowledge acquisition often happens on patient education portals, but rarely gets translated into actionable, bite-sized skills to be practiced in the real-world. In our early conceptualization phase, we’ve outlined five different strategies to create an end-to-end learning experience for self-management, and we’ve decided to prototype this one through the small clip below. The idea is simple: learning occurs on a large screen, in the privacy of a patient’s home. The patient then selects the desired skill to integrate and a module is loaded onto his companion (mobile) app. The thought here is that different technologies can work in tandem. While learning requires concentration and space, everyday activities require native functionalities such as reminders, prompts, or ways to quickly input progress/actions. By dividing the learning from the applying experiences, we help patients move from passive information to action.
Feedback
Written by GyuEun
Self-Management
- Interesting that emotional care is what surfaced in the research
- Looking into varying ways people identify their own emotions when dealing with a chronic illness or trauma
- Exploring the possibilities of creating something physical to learn something abstract
- Prevention: a good method to help college students to understand how important health is/how to stay healthy.
- “Delve into the patient experience — at which point would [learning] be the most important?”
- Focus on patients/self-management, but narrow the focus and pick an area/disease to really go in-depth with the patients. “Any topic you choose will have a wealth of resources and areas you can improve frameworks.”
- Scaffolding: important to motivate and support your target audience
Relationships
- Boundaries — a communication skill problem or a knowledge skill problem?
- A doctor’s advice being fairly rudimentary — perhaps other considerations (literacy, understanding of physiology) drive the distrust/dismiss
- Learning opportunity: “General advice is still good advice, but if it does not feel particular to the patient, it makes sense that it would be dismissed.”
- “Community is a wonderful idea” — “linking people together that they can be proud of (deep trauma that family/friends might not understand)”
- Creating an experience for patients or support people (family and friends), or both? “Seems like you’re focusing on patients, but I feel that getting families and friends might be a key..”
Data physicalization
- Using physical objects to express the embodied experience of both successes and failures of self-care?
- Should be fun and trustworthy but not intimidating
Resources
- Corine Britto, a second year Master of Design student (experience @ Mayo clinic + Interview Results)
- A Japanese group in Pittsburgh in which people meet once a month to learn about one health topic that is really relevant to them (lecturing or workshop and usually more than 15 people come to learn and also connect with each other.
- Bedsider by IDEO in the sexual health space
- IA Collaborative project, facilitating conversation between doctors and diabetic patients: https://iacollaborative.com/work/dexcom/
- Instagram pages: kids.eat.in.color, mastering diabetes. “They have a huge audience and it might be good to analyze what are the features which make the people attracted to them.”
- Look for non-traditional, innovative approaches
Strengths of the Presentation
- Research & discovery: existing frameworks, tools, resources, assessing what the current state looks like.
- Clear design question, visualization
- Important finding/realization: existing tools push what to learn to users. a ‘push’ rather than ‘pull’ mechanism
Narrowing the Scope
Written by GyuEun
The self-management skills we aim to teach revolves around fatigue. In short, fatigue is a chronic condition that drains your energy. However, it’s important to note that it is not all in the mind, as a lot of people think.
Context
Below is a summary of the basic information on diabetes provided by Mayo Clinic. There are multiple conditions that result from various underlying causes, and we will have to narrow down our scope.
Diabetes mellitus refers to a group of diseases that affect how your body uses blood sugar — glucose.
What is glucose?
- an important source of energy for the cells that make up your muscles and tissues
- brain’s main source of fuel
While the underlying cause of diabetes varies by type, diabetes can lead to excess sugar in your blood, which can lead to serious health problems.
Chronic diabetes conditions :
- type 1 diabetes
- type 2 diabetes
Potentially reversible diabetes conditions :
- prediabetes (when your blood sugar levels are higher than normal, but not high enough to be classified as diabetes)
- gestational diabetes (which occurs during pregnancy but may resolve after delivery)
We have decided to direct our focus to type 2 diabetes —
Focus: Self-management
We, as a team, have decided to teach fatigue management skills. We believe it is a topic that is applicable to everyone with diabetes, as well as to those who do not have the condition.
Broadly speaking, in order to teach our learners methods of fatigue management, we will provide them with the information they need to understand the various factors that lead to fatigue, and consequently, they will be able to identify the specific factors that cause fatigue for them on an individual level.
Then, they will acquire knowledge regarding strategies that can use, which will be implemented into their daily lives, and the changes, progress, and journey will be tracked and visualized.
Cycle of practice and feedback will be extremely useful for our case. We want our users to identify desired results and personal goals, which will impact what they need to learn. The learning will help guide their future actions, and practice and targeted feedback will lead to improvements.
We also want to help the learners acknowledge the short-term and intermediate goals, as well as long-term goals. It will be vital for them to define smaller tasks that can be carried out consistently, in order to meet the long-term goals they set for themselves.
We must also be conscious of the fact that some patients have extremely thorough understandings of their own conditions. This may require further personalization of the learning experience.
Motivation
Written by GyuEun
Instrumental value represent the degree to which an activity or goal helps one accomplish other important goals. When dealing with fatigue, the goal is to minimize its effects, in order to focus on other aspects of daily life. Efficiency and balance will increase as the level of fatigue decreases.
It is our hope that our learners attain a sense of accomplishment by setting realistic, small goals. This will establish attainment value, or the satisfaction they gain from accomplishment, as well as increase the personal investment that an individual has in reaching a desired state or outcome.
Understanding Fatigue
Written by GyuEun
Trinity College Dublin Disability Service’s Balancing the Books: Managing Fatigue in College — Staff and Students provides information on the condition, answers commonly asked questions, as well as “Thinking Activities” exercises.
The authors note that the causes of fatigue are still not wholly understood, but most cases of may be attributed to three main areas: lifestyle factors, medical conditions, or psychological problems.
Fatigue can be caused or intensified by poor lifestyle factors such as:
- poor nutrition
- alcohol
- caffeine use
- lack of sleep.
Some believe that fatigue emerges as a result of a Western lifestyle (Dawson, Noy, Harma, Akerstedt, & Belenky, 2011) — people have too much to do and not enough time to do it- they suggest this level of over-activity can trigger fatigue.
Fatigue can also happen if you have been doing too little.
In some cases, fatigue is caused by the body’s response to the demands of a physical illness (physical disability, medical condition, etc.) For example, weakness or stiffness in the body can mean that activities may require more energy to complete, so energy runs out quicker.
Illnesses such as chronic fatigue syndrome can emerge after a viral infection in the body. Living with a disease or medical condition can be inherently stressful, and stress in turn can contribute to fatigue.
Fatigue can be a common symptom of mental health difficulties or psychological difficulties (anxiety, depression, post-traumatic stress disorder, bi-polar disorder, etc.)
There are many causes of fatigue, and a person’s fatigue may not be caused be a single factor, and may be intensified by others. The combination and variance of contributing factors means that fatigue levels can vary from day to day and within the day.
While fatigue and tiredness share the same characteristic of low energy, they have differences. It would be important for our learners to understand what fatigue is, and how it uniquely affects their lives.
The understanding would help them set specific goals and acquire self-management skills and habits.
Preparing Interviews
Written by Corina Paraschiv
Next week, we will be interviewing a series of experts acting as proxies for our target population. We decided to focus on fatigue management, which is common and relatable for many people.
The Experts:
- Dietician
- Care Coordinator
- Nurse
- Master Student with internship experience in hospitals
The Testers:
Testing has two functions — first, validate that what the experts shared was an accurate reflection of the patient's learning experience (by asking learners); second, test out a prototype and collect feedback to improve it.
We originally wanted to use the meditation room as our recruitment point for participants, but seeing the Coronavirus exploded, we shifted to online.
We created a post for our social media, which was effective in recruiting participants within our networks. Ivy rendered it in Figma, so that is could have a professional look and feel.
Interview Notes
Interview with dietician Barbara Benedict
Written by Corina Paraschiv
“If you came home exhausted and had to choose, which of these three would you reach out for?” Dietician Barbara Benedict was showing us the many tools she uses to help patients with fatigue management.
A few things we learned :
(1) Visuals exist both for tangible (ex. portion controls) and intangible things (ex. glucose absorption rates through the body). It is not sufficient to teach behaviors — decision-making involves “diagnosing” a need in real-time.
(2) Unlike most tasks within our society, there are no penalties to others when a person does not take care of themselves — the only penalty incurred is on the individual himself. Making penalties visible may help patients.
(3) People typically seek help with fatigue when they can no longer function. This has implications for both entry points and motivation management.
(4) The gap between knowing and doing seems to be motivation (ties to discipline, immediate gratification and impulse control) which is especially hard for patients facing multiple issues.
(5) Quick wins are crucial at the start.
Notes from Interview with Nurse Coordinator Heather Yankura
Written by Xiaoyu
We visited Heather Yankura at the University Health Services Center on Monday. This time we brought the same list of questions as in the interview with Barb, but hope to get different perspectives about fatigue management.
- Fatigue management has many causes. The general approach is to learn about the student’s detailed history with regards to diseases, medical treatments, sleep, and nutrition, ask about their daily habits and evaluate their ability of self-management.
- People’s descriptions of lifestyle may be subjective and use different wording from doctors, which may hide their potential problems. For example, Heather mentioned about the caffeine intake — A student said he drank one cup of coffee a day but turned out to be putting four shots espresso inside one cup.
- People come with own expectations on the diagnosis and treatment, and different level of prior knowledge, which have a significant influence on their acceptance on doctor’s suggestions. Heather mentioned, students expected to be diagnosed as physical rather than mental issues, because mental issues are harder to tackle and don’t have concrete and quantified prescription comparing with physical issues. Besides, people accessed different resources from online or family before going to see the doctor, their prior knowledge sometimes does not match the advice provided by the doctor. This makes the doctors very hard to get their advice accepted by the patients.
Notes from Interview with Master Student Corine Britto
Three resources were particularly enlightening for our purpose:
- Using Diaries to Probe the Illness Experiences of Adolescent Patients and Parental Caregivers, Matthew K. Hong & Al.
- Uncovering self-management needs to better design for people living with lymphoedema, Teksin Kopanoglu & Al.
- Teaching Patients with Advanced Cancer to Self-Advocate: Development and Acceptability of the Strong Together-Serious Game, Teresa Hagan Thomas & Al.
In addition, we explore a lot on the emotional journey of patients and the cultural implications of trusting/not trusting a system, or being familiar/unfamiliar with a system. Based on the interviewee’s internship experience.
Notes from Care Coordinator Diane Dawson
The emerging points were coherent with other experts interviewed. Patients’ main difficulty with self-management seems to be lack of time, trade-offs evaluation (short-term vs long-term) and lack of self-awareness.
This expert confirmed there is a real need to improve the learning experience for self-management, with an emphasis on motivation.
Post-Interview
The Spoon Theory
Written by GyuEun
Our interview with Corine, a former intern at Mayo Clinic, provided insight into The Spoon Theory, which our group found extremely relevant.
The Spoon Theory is a creative method of explaining to families and friends the reduced amount of mental and physical energy that is available for productive activities and tasks.
Here, spoons function as a visual representation and a unit of measurement that quantifies how much energy an individual has throughout a given day.
Each activity requires a certain number of spoons, which will only be replaced as the individual recharges through rest.
Methods as such not only facilitate communication and understanding, but also provide opportunities for individuals struggling with fatigue to effectively allocate their energy throughout the day. In the process, they reflect on their needs, priorities, and goals. This aspect will also be important for our project.
In addition, it is crucial that the learning experience does not become a burden for those who are already struggling both mentally and physically.
Interview Synthesis
Affinity Diagram
Written by Corina Paraschiv
Our interviews revealed four big topics being discussed in learning to self-manage:
- How does a person learn to identify their problem
- How does a person decide which strategy to implement for their particular circumstances
- How does a person learn to work with the healthcare system
- Design Principles for our Solution
How does a person learn to identify their problem?
- What’s bothering you? (Motivation)
- Why now? (Trigger/Opportunity)
- What are you trying to achieve? (Readiness)
How does a person decide which strategy to implement for their particular circumstances?
- What obstacles do you see?
- What resources do you have available?
- What should you tackle first?
- How will you know a strategy you’ve tried “worked” for you?
- What did you try? What worked, what didn’t?
How does a person learn to work with the healthcare system?
- How willing is a person to hear a diagnosis/label?
- What data/information could the patient collect to help diagnose?
- What makes a good diagnosis to that patient?
- Who knows best: patient, family/friends or doctor/pharma?
- What are your expectations for treatment?
- How much/little information do you need to feel empowered in your treatment?
- Who is in charge of the process: the doctor or the patient?
- What is the patient’s level or trust and confidence with the system?
Design Principles for our Solution
- Honor people’s constraints or priorities (ex. studies)
- Offer tailored solutions
- Avoid creating negative emotional experiences (ex. frustration over wasted time, additional stress, etc.)
- Incorporate Motivational Interviewing
- Allow compromises (imperfect solution vs no solution)
- Inclusive communication and treatment
- Tap into self-persuasion
- Tap into intrinsic motivation
Motivational Interviewing
Written by GyuEun
Motivational interviewing was formed by William R. Miller and Stephen Rollnick as a way to push past the issue of low motivation to change.
It is a psychotherapeutic approach that attempts to move an individual away from a state of indecision or uncertainty and towards finding motivation to making positive decisions and accomplishing established goals.
Motivation is essential for progression, and lack of motivation is one of the major challenges for individuals struggling with fatigue.
The learning experience we aim to design will not address the lack of motivation through confrontation, or pressuring the individuals to change.
Therefore, we see motivational interviewing as an extremely effective method to spark motivation and initiate change for its emphasis on a non-confrontational, collaborative effort. It engages individuals to explore feelings and to find their own motivations. Throughout the process, the autonomy of the individual is respected, and their intrinsic resources for change are elicited.
This method has the potential to change longstanding behaviors, build motivation to change, and to strengthen the commitment to change — supporting the goals of our project.
Getting Ready for User Interviews
Written by Corina Paraschiv
Having now recruited users and synthesized our findings with experts, we are creating a deck of cards in Adobe Illustrator, to be used for identifying which of the strategies highlighted by experts work/don’t, and to drive discussions over the process of learning how to implement them (for patients).
We are now producing the cards (ready by tonight) and designing the close-sorting activity. Testings will take place between Wednesday this week and Wednesday next week.
We are using the book Card Sorting by Donna Spencer as a guide for structuring our user research.
We’ll be recording our data in tables that allow us to quickly see statistical correlations. These are a template provided by Donna Spencer which we can use without needing to code anything further.
In the first sheet, we simply record each category that the user placed our card in.
In the second tab, we get a consolidated view of all the card sorting from all participants. This automatically appears without us needing to input anything.
In the third tab, an automated color-coding algorithm shows us a “heat map” of the categories frequently identified for each card.
We will combine these quantitative measures with the qualitative information collected while sorting with participants.
The goal is to understand where in the learning process to self-manage the participants get blocked so that we can help unblock them through our solution.
Presentation on Motivation and Engagement
Written by Ivy
In week 10, we presented our initial ideas about how to engage users in learning fatigue management.
From our previous research, we found out some main factors that have effects on fatigue management:
- Social
- Discovery/Boredom
- Cause & Impact
- Effort & Time
- Emotions
- Accountability
- Embodied Awareness
Comparing different age groups, students are less conscious about their fatigue, because their time schedule is more flexible, it’s easier for them to make an in-time adjustment. However, for office workers, most of them are knowing they have fatigue management issues due to intensive daily work. Their problem tends to be a lack of time to rest.
Due to the clear difference as well as the nature of fatigue management — there’s no single strategy fits for all, we decided to encourage people to do trial-and-error to find their own strategy.
What can we do to increase learners’ motivation?
We leveraged this model from How Learning Works to design our engaging experience.
The Value of motivation:
- Attainment value — well managed energy level
Leverage models, visualizations, animations to help the learner see the value of fatigue management.
- Intrinsic value — find the activity that the learner enjoys
Design rewards as an incentive to add pleasure to the learning journey.
- Instrumental value — to improve efficiency and wellness
Make the improvement explicit. For example, tracking progress and visualize the journey, and conduct self-evaluation to increase learner’s awareness of changes.
The Expectancy of Motivation:
- P — positive outcome — better control of their life
- N — monitoring changes to stop the ineffective activities from disrupting their life
- E — visualize the improvement
The model below shows how to motivate the student in a learning environment considering three factors: support from the environment, students’ efficacy and whether student can see the value. To reach our learning goal, learning should be supported.
Therefore, we want to introduce social elements into the system.
How can we assist memorization?
- For short-term, working memory
Learn by doing, recap and self-evaluation
- Long-term memory
Enable repetition, One option chosen within a structure
Visualization of the Learning System
Our initial idea about self-management is a system that provides multiple skills to learn. Every time, users can select one strategy to tackle. Then this learning experience goes into the loop of practice and feedback. When the user succeeds in this strategy, he can share his experience with the community for both collecting feedback and offering help.
In this course, we will only prototype the module about fatigue management.
We merged two models: the Structure of Goals & Development of Mastery to show the four stages of management skill mastery and the corresponding level of knowledge & skill requirements. We want to tackle the middle part Experiment & Apply to help learners transit from “Conscious Incompetence” to “Conscious Competence”. However, we realize from interviews that even if people know they are incompetent on fatigue management, they still have problems on taking actions. For this problem, we want to include Self-Evaluation in the Explain & Interpret section into our module.
Summarize on Card Sorting data
Written by Ivy
Last week we counted the cards for sorting results, and Corina made a spreadsheet to analyze data.
First, we found out the main challenges that people have with regards to fatigue management:
- The fear of failure
- Hard to be aware that you have limited energy because energy is invisible
- Tracking energy looks like too much effort
This guided us to think about how can we leverage our design to solve the problems. For example, can we visualize the energy level, and can we make the tracking less time-consuming?
Later, we did another analysis of the potential strategies. In the card sorting, we asked participants to drag effective strategies into one category, ineffective ones into the second category, and then placed the remaining ones which they haven’t tried into the third category. From the data, we got some strategies that were taught useful but some people hadn’t tried. We selected three strategies based on existing challenges and feasibility. Can we leverage them to design our learning experience?
Thinking about Form
Written by GyuEun
After individually brainstorming and sketching for several days, we came together as a team to discuss the potential ideas.
We then discussed and noted the strengths and weaknesses of each design to decide on three final ideas. We tried not to focus too heavily on the level of feasibility, and avoided strictly defining the ideas as either physical or digital.
In the process, we also took into consideration the different strategies that were preferred or desired by our interviewees :
Idea 1 : Visualizing Energy Management
Idea 2 : Budget Allocation
Idea 3 : Note-taking / Journaling
We also created storyboards and gathered some questions we have.
Here is the latest version of the learning system, which integrates 1) a cycle of practice and feedback and 2) a structured flow of goals.
Taking this model into consideration, we created our first journey map:
The map outlines the learning system (both internal and external), user actions, and the various learning components. Our focus was on the system itself and the ways in which each step could guide learning.
Defining the strengths and weaknesses of our three final ideas helped us design a new, refined version.
We maintained the usage of visual metaphors, reduced the complexity and the degree of responsibility placed on the user, and took into consideration when the user would need the learning system the most.
The solar car was chosen as the concept, or visual metaphor of our learning system. Its connection to energy is quite straightforward: the car recharges, gains and loses energy, just like the human body. It continues to move forward, but needs rest along the way.
Above is our plan for user testing. Before that, however, we plan to brainstorm further about ways to boost the learners’ motivation: their motivation to not only return to the system but also to continue their journey.
These are some of the rough ideas we have — they will be modified and organized soon:
IDEAS FOR MOTIVATING USERS
- Personalized suggestions [dashboard]
- This worked / didn’t work for you in the past
- “more like this” (strategy recommendations) based on big data (other users who shared the same strategies as “worked” also did well with these)
- Random cute videos appear after you collect different countries — some videos are random, some are pre-announced (ex. On your 50th country, etc.)
- Videos are more frequent at the start (motivate and hook you), then they become less frequent
- Videos are educationals and motivational: explain how to create new routines, how to learn through trial-and-error, the benefits of a stress-free life, the link between energy management and other health factors, etc.
- Users can collect “countries” (stickers, map, postcards, mysterious gift…?) as they progress through their journey
- Strategy of the day gets you special sticker/map/postcard with extra miles — if you try it, your car gets extra energy or extra miles
- User only has to answer 4 questions, drop-downs, this is not long : the payoff (knowing thyself) is greater than the cost (taking 5 minutes to fill in your day log)
- Maybe we push a notification or have the user set a reminder on their clock daily to remember to check in (or maybe it’s an email)
