UX Designer | Human Computer Interaction
Community Health Workers
Point-of-Care App Case Study
HCI Master's Program CAPSTONE Project
Designing technology that maintains and encourages human connection
CLIENT
School of Public Health & Horowitz Center for Health Literacy
Conducts interdisciplinary research in health communication and health literacy and translates research findings into education, recommendations, policy proposals, and community action
LOCATION
University of Maryland, College Park
SECTOR
Health, Health Literacy, Academia
MY ROLE
Designer, Visual Design Lead
PROJECT TIMELINE
Sept 2019-May 2020
FINAL DESIGN
PROJECT BACKGROUND
I worked with a team of four other designers to design and prototype the first version of a point-of-care tablet app for Community Health Workers (CHWs).
We conducted research and established the design system, iterated the product structure, and refined several versions of design.
Team
Shannon Cates
Lindley Dahners
Astha Khurana
Shravya Simha
Simone Pimento
Methods
Competitive Analysis
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Contextual Inquiry
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Experience Models
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Co-Design
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Contextual Design
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Remote User Testing
Tools
Figma
Zoom
Whiteboards and sticky notes
PROCESS
After background research, we followed the process of Contextual Inquiry by conducting user research. After synthesizing inspiring insights from user interviews, we defined the problem and jumped right into the ideation phase. From sketched product concepts all the way to high fidelity prototypes, we gradually created and iteratively tested versions of the application.
Main Dashboard
Quick Access Bar
Everything related to a particular client lives within the My Client tab.
My Client Tab
Client Lookup
Client Profile
Today's Notes
Note-taking during the client visit is where CHWs spend most of their time.
Visit Notes
Past Notes
Notes Summary
Goals
Add New Goals
Setting goals with clients in the app helps keep CHW and client accountable
To-Dos
CHWs can keep track of all tasks in one place
Save resources, forms, and visual aids to a particular client’s library
Resources
Visual Aids
Client Library
FUTURE DESIGN STEPS
We presented our final design to our client in May 2020. SPH intends to work on developing and continuing to test the design. We are currently working with SPH to write a paper about our research.
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Adapt the technology to the new virtual-point-of-care environment
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Uniting goals and to-dos
REFLECTIONS
Every CHW organization has an extremely different means of operating and, within those organizations, each CHW also has a very unique approach to their job. Making design decisions based on such varied and inconsistent data was very challenging. I learned to make decisions that would be beneficial to the most users, while keeping in mind that the designs needed to not be so radical in one direction that they excluded other means of doing things.
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Vector Illustrations adapted from artwork by PixelTrue
CONTEXT
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Sarah is a CHW. She, like most CHWs, got into the field because she has shared life experience with her clients. In her case, she is a single mother who experienced what it was like to be low on resources and information.
Sarah meets face-to-face with a new client, Joseph, in his home. She keeps up a friendly conversation with Joseph. She worries that using a laptop or her phone or even pen and paper would put up a barrier between her and Joseph, so she remembers the conversation and takes notes later. She carries around a folder with copies of all of her resources.
“Patients feel suspicious if I use a laptop to note down their information. They wonder where that information is going.”
Sarah has a lot of patients and her organization requires her to update many different databases to satisfy their different grants. She looks up patients and resources in an excel file that she shares with other CHWs. Resources are frequently out of date, and she finds herself making a lot of phone calls to find the right help for her clients.
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WHAT IS A CHW?
CHW are trusted community members who bridge the gap between the community and healthcare system. They work with an organization to find clients and assist their clients with any aspects of their life that contribute to their overall health and well-being.
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Foster health literacy
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Mediate between people and healthcare professionals
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Community outreach
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Help navigate health and social systems
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Guide clients to self-sufficiency in their health
Social Determinants of Health are a series of topics that can affect an individual’s ability to maintain and improve their own health. These are items like food, social support, finances, etc.
CHWs ask their clients about these during home visits, but they generally have to remember all of the information for later or else fill out paper forms.
BUILDING EMPATHY
DAY IN THE LIFE MODEL
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No two CHWs have the same process, and everyday is different for a CHW. They do a lot of tasks for their clients, like picking up medication, and may respond to client needs at the drop of a hat. Many of them did not have a good system for keeping track of what they needed to accomplish.
IDENTITY MODEL
During our use interviews, we noticed a number of identity elements coming up and used those to compile an identity model that represents the types of identities CHWs may relate to. Of course, the model is not comprehensive or exclusive, but it shows that CHWs have a variety of motivations and approaches.
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IDENTITY MODEL
DAY IN THE LIFE MODEL
RESEARCH
When conducting background research, we found that not much research had been conducted into the workflow and needs of CHWs. We also found that although some technologies existed to help CHWs, they were mostly intended for use in remote areas. Because of this lack of information, we kept our interview focus quite broad.
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Because of HIPAA concerns, we could not directly observe CHWs with their clients or view their real calendar or databases. According to Contextual Inquiry, we asked CHWs to walk us through a specific day in their workflow as well as to recall their last client visit. We took notes on their training, personal workflow, client interactions, how they create interventions, as well as current practices and pain points.
In accordance with the Contextual Inquiry model of user research, we built a large affinity model, containing all of the insights from our user interviews. This allowed us to iteratively converge and diverge insights until major topics bubbled to the top.
OPPORTUNITIES & CHALLENGES
VALIDATION
We were able to show this first stage of our research to CHWs and validate our analysis. We also used this opportunity as a precursor to our co-design session, gathering design ideas and challenges from our CHWs.
AFFINITY MODEL
IDEATION
After synthesizing the insights from our use interviews, we began several rounds of ideation and created a few product concepts. We presented these to our client and narrowed it down to one concept.
HOW MIGHT WE...
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Help CHWS organize and access up to date resources
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Help CHWs educate clients at the point of care
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Enable CHWs to take notes during a client visit
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Integrate technology into the client visit in an organic and non-threatening way
Does the problem require a technology solution?
Much of our data was conflicting regarding CHWs tech-savviness, as well as their and their client’s openness and access to technology. It is important as a designer to ask if a technology intervention is the right choice.
Eventually, we did determine that right technology could answer many of the problems CHWs disclosed. However, that technology would need to be simple, with quick and easy interactions that did not take away from face-to face discussion.
REFOCUSING ON THE CLIENT VISIT
From our interviews we knew that client visits vary by CHW and by organization. However, an overarching model began to appear.
At first, we felt the client visit was a relatively linear process.
However, during our co-design we were able to speak with more CHWs and found that the model is much more organic.
Intake & Education take place during one long organic conversation, after which a CHW may set goals with the client. They do the majority of note-taking and their personal to-do management later.
VISIONING
DESIGN GOALS
After narrowing down our product focus, we began to crystalize an initial product concept.
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DESIGN PROBLEMS
DESIGN METHODS
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Storyboards
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Screen Flows
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User Flows
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User Environment Diagram
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Wireframes
STORYBOARDS
WIREFRAMES
PRODUCT CONCEPT
Interactive Point-of-Care Tablet App
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Note-taking that uses categorization to let CHWs take quick notes based on the mental model they already use
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Compact goal setting flow with optional reminders
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A database of resources and visual aids with clearly marked dates, locations, and other info CHWs use to match with clients
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To-dos organized by clients as well as category to help CHWs keep track of everything that needs to get done in a way that matches their complex workflow
WHY TABLET?
CHWs felt very strongly that tablets were a great choice for in-home visits because they were not reminiscent of doctors or nurses and can be easily shared with the client so that they can see what the CHW is doing.
CO-DESIGN
We took our initial sketches to our co-design session and worked with CHWs to adapt our design.
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DESIGN CHANGES
Our initial design featured a linear intake walkthrough that would guide CHWs through the visit. However, after our co-design session, we determined that the client visit is much more organic and adapted our product structure to be more flexible.
During our co-design session, we also found that CHWs think of resources and visual aids as separate entities. In both cases, the CHWs wanted to be able to access these materials as needed during conversation with relatively little time spent.
We addressed this concern in three ways. First, we decided to split the resources and visual aids into separate tabs. We also included a quick access bar that enabled CHWs to access commonly used materials from any page. Finally, we enabled CHWs to favorite materials as well as save them to a particular client’s profile.
REMOTE USER TESTING
We tested our design with 6 CHWs. Because of the COVID-19 quarantine, we had to conduct all design and user testing remotely.
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DESIGN CHANGES
We knew that the notes feature needed to be somewhat different from a typical note-taking app because CHWs had mentioned that they carry on an organic conversation and do not want to be bogged down. We decided to implement sectioned notes that were categorized by the Social Determinants of Health as this was they way that CHWs told us they mentally organize their conversations with clients. We hoped that this would help CHWs to take quicker, more organized notes.
We also worked on ways to integrate past notes with new notes for quick reference.
DESIGN CHANGES
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In our original design, we allowed CHWs to search for clients in a list. However, we discussed with healthcare professionals, design experts, and CHWs and decided that such a list could violate HIPAA regulations as it may allow clients to glimpse information about other clients. We changed the search feature to require first and last name as well as date of birth, based on healthcare standards.
