Boulevard
Elevating patient experience at home for better recovery outcome
Project Summary
Designing support for more than 100 million patients recovering at home
Have you ever experienced any illness that takes more than a week to heal? More than 100 million adult Americans develop musculoskeletal diseases that require more than three months to heal.
For my MHCI Capstone project, my team Well21 worked with Optum to design a digital tool called Boulevard for these patients recovering at home. Boulevard raises motivation, instills a sense of progress, and celebrates each milestone with the patients. Through this mobile application, we support patients at home for better recovery outcomes.
My Roles
I led end-to-end user research, from research planning and protocol writing to interview moderating and data synthesis. I contributed to prototyping and user experience design by sketching ideas and informing design decisions with research findings. I also co-managed the project by creating project plans and leading standup meetings.
Our Challenge
How might we improve patient compliance with limited clinical hours?
About 65% of physical therapy patients are unable to fully comply with care plan, leading to incomplete recovery and re-injuries. Such re-injuries are costly to the patients' body and to the payers. However, due to high expense and therapist availability, patients typically have seven to ten physical therapy sessions in the three to five months of recovery. It often is left to the patients to keep up with their care plan. My team identified this challenge and worked to address patient compliance issues.
Change of Mindset, Change of Approach
Rethinking patient care as a service
As we talked with current and past PT patients, I started to see the complexity and the sensitivity of the recovery process.
Healing is not just about compliance. Apart from checking off the sets of leg lifts, there is much more the patients have to deal with—pain, tears, and hopelessness.
Healing is physical and emotional. At their most vulnerable moments, patients don’t need another notification reminder, they need a companion to turn to, some confirmation for their progress and even just a cheer.
So the team decided to reframe the project to:
How might we guide and motivate patients towards successful recovery?
Problem Space
We found key user values through generative research
We designed and conducted seven studies to build our understanding of the health and wellness problem space.
One challenge we encountered was data synthesis. We needed to make sense of the rich data set we collected and derive insights to guide our next steps. Coming up with meaningful insights is not easy, and we had over 100 sticky notes on our affinity diagram. We spent more than 10 hours across three days synthesizing and discussing as a team.
After hours of synthesis and team discussion, we generated six insights and established three user values that guided our prototype design through the rest of the project.
User Value 1: Adaptable Solutions
- When my situation changes, I become aware that I can change my behaviors to pursue health goals.
- When I feel well, I see myself as healthy.
User Value 2: Information Collection
- Managing health is stressful, so I use my experience to guide me.
- I need the right care at the right time, but don’t know where to look for it.
User Value 3: Motivated Action
- When my health is struggling, I look for anything to help myself feel more in control.
- Being healthy all the time is hard, and I need help to do it since I usually fail.
Iterative Design
Using established user values to guide design sprints
With the shifted scope of supporting recovering patients, we selected physical therapy as a use case to build out and test our prototype.
Based on the three key values, we came up with the following questions that we wanted to address in our design:
To answer these questions, we iteratively and rapidly went through the design cycle. Guided by the Google Venture sprint schedule, we focused on one research question per sprint—we brainstormed ideas, prototyped the ideas, tested them with the users, and iterated based on the feedback.
During each sprint, I led the study and protocol design, participants recruitment, testing, and synthesis sessions that led to the following findings.
%20(Mockuuups%20Studio).png)
Sprint 1: Progression
How might we communicate the patients’ status and progress?
We designed a mobile app prototype with visualization of progress and tested current and past patients’ understanding of their progress based on their recovery experience and with the app. With the intention of both validating the idea and testing the usability of the prototype, we used interviews and think-aloud to test the prototype with six past or current physical therapy patients.
Findings:
We found that five out of six participants indicated an improved understanding of their status and progress with the app.
Sprint 2: Personalization
How might we personalize the tool and where is personalization needed?
We created an onboarding experience where information is collected to personalize the recovery experience. We tested the prototype with seven past or current physical therapy patients and used a card sorting activity to understand recovering patients’ information prioritization.
Findings:
- Seven of eight participants were comfortable setting their recovery goal, photos, and push notifications.
- Sharing calendar data with our app was the most apprehensive part of onboarding; two participants skipped and two expressed verbal hesitation before agreeing.
Sprint 3: Motivation
How might we motivate patients to continuously put in the effort towards healing?
We connected healthy in-app activities to a positive motivation system focused on charitable contributions. We tested people’s reactions to the reward system and used a 10-day longitudinal study to measure the impact of rewards on people’s adherence.
Findings:
- When asked about the rewarding nature of this interaction on a scale of 1 (least rewarding) to 5 (most rewarding), participant responses averaged 4.71, suggesting people highly value helping others.
- 5/5 completed exercises based on prescription and injury condition with the donation reward system, compared to 3/5 without.
Sprint 4: Translation
How might we translate the application from physical therapy to Covid-19?
We created a version of the app for COVID-19 to test the translation process from physical therapy to COVID-19.
Findings:
The translation from physical therapy to COVID-19 recovery was also successful. Six out of the six participants acknowledged that they would use our prototype during recovery.
We validated the user need and our prototype through four rounds of interviews with 32 participants and a longitudinal study to test the impact of reward on people’s adherence over time. The result was positive: the need for symptom tracking and progress understanding was prevalent, and the majority of participants indicated that they would use the prototype during their recovery.
Final Prototype
I used user data to inform prioritization in prototype design
During each design sprint, we held a synthesis session to interpret the data collected and translate what we observed into actionable items. One tool we used is a MoSCoW board to help us prioritize the potential prototype changes, including both usability issues and feature recommendations.
We compiled all the prioritized feedback and landed on our final prototypes (Physical therapy prototype and COVID-19 prototype). In the final solution, we incorporated daily check-ins and monitoring, a donation-based reward system, a phased progress system, and the information collection onboarding.
Learn more about our solution on our project website.
Reflection
Using research as the guardrail in an evolving context
Our initial mission was to support the development of a return-to-work application—ProtectWell. However, with wide vaccine distribution, the landscape of workspaces changed quickly, so did our project scope.
To understand the opportunities in the shifted health space, we collected data through surveys, interviews, and simple prototypes. In these studies, we found a significant increase in telehealth as well as health awareness. People are much more willing to engage in health and wellness digitally from their homes now than ever.
We identified the opportunity to be supporting recovering patients in their at-home recovery. With active communication with our client along the way, we received support and approval for our adjustment to the changing context.
Methods should be customized based on specific needs
During this project, as the UX researcher, I also realized the importance of both being able to select the correct research method as well as adapting the method based on the context and goals of the project. In one of our sprints, we used card sorting to understand people’s prioritization of information where we asked people to organize by frequency instead of letting them group and label the cards based on any categorization. However, this constraint gives us the most useful data because we were only interested in how frequently people need each piece of information. In my future work, I will keep in mind that the defined research methods can be adjusted and customized to better serve specific research needs.
The planning is as important as the execution
Despite being a class project, this project gave a lot of freedom to the team in terms of defining our scope, our focuses, and our specific timeline. Freedom can create a lot of confusion and misunderstanding. Planning and defining the scope becomes especially important and other team members had expressed gratitude towards Steve and myself for our project management. We often had multiple deliverables due on the same date. The actions of making a reasonable plan with time estimation and explicit work distribution, as well as monitoring progress and update the plan consistently made our work process so much smoother.
