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Category Archives: Reflection

Creating the right pilot: Trust your gut, focus on the ideal

This week I waited for my recordable greeting card to come in the mail. Anticipating that the idea was to establish a conversation with individuals, via a pen pal type situation, recording reactions and reflections that were then sent back to the first user, then to another individual to reflect or react to by recording a verbal message.  I would then use contextual inquiry to identify if this back and forth conversation (revolving around the stigma of mental illness) was helpful for the initial user in disseminating the stigma that they had to keep their condition a secret, and to be more comfortable speaking out and owning their condition, because they were at least virtually interacting with others that could identify with their emotional state on a personal level.

Unfortunately, the card did not come in, but during this time of waiting for the card to come in the mail, I was challenged with the opportunity to take a step back and ask if this was really the correct way to pilot my ideal final product. Which is a 2 week trial pack of a mood disorder medication, which included recorded stories of others who have similar conditions and how they deal with emotion, medicaiton, and manage self care. As of now I can only equate my final ideal product to the idea to those voice recorded Hallmark story books, where a child can be told a bedtime story by a loved one who may live across the country.

Yet as I was waiting for my order to come in, to pilot my idea, I had in the back of my mind that this is not the correct pilot, I just felt it in my gut. My ideal end product is actually not necessarily a back and forth conversation as the initial pilot would suggest, but a book of real people with real stories about how they felt and dealt with issues surrounding their life before a diagnosis. Then how they felt and managed getting a diagnosis, being prescribed medication, and how they felt with the idea that they may have to maintain a medication regimen perhaps for the rest of their life.

I did not believe in my first pilot idea, so I went with my gut and started gathering stories, from real people in their own words. That is what I wanted in the first place and admittedly should have spent the past week gathering these stories.

The past being the past it, was time to get to work. I created a script of questions and recruited 2 individuals to interview and record in order to deliver these stories to someone who may be hesitant to seek help, whether by stigma or general fear of a diagnosis that required them to potentially take a medication that helped them reach self-care in the long term, possibly for the rest of their lives.

This is what I did today. Surprisingly people who suffer from a mood disorder (bipolar spectrum or depression) understand what the condition is like and are more than willing to share their own stories if it has the potential to help release the stigma of being the odd man out, or the damaged ones, as well as put them at ease about the idea of having to be medicated in the long term in order to reach the goal in life they seek.

I also learned the importance of getting this information out of the computer and on to the “wall”. The wall being a place where you can visualize your journey and ideas, inspirations and wishes that you can physically look at and see on a daily basis. This allows you to be able to see where you have been, where you are going, and where you want to be. To iterate, and I acknowledge I should have done this sooner. I should have trusted my gut.

Out of respect of the two individuals I will not post the recordings until next week when I am able to edit down to the core ideals I am initially going to pilot, to a new “patient” with the same hope that it will aid in creating a virtual bond with my recorded individuals and their experiences in hopes that the stigma of being judged as the damaged one, as well as the realization that it is ok, and rather normal, often rather necessary, to seek aid of a medication regimen is not weird, or uncommon.

My pilot has changed. I now have the necessary stories/tools to relay to someone who may be feeling like they are “not normal”, but being not normal is actually ok with the appropriate treatment. Some of the greatest minds of our time have been “not normal”, and have gone on to make a true effect on changing the world.

I truly was fascinated and inspired by hearing others give their trust and conviction in helping others by revealing their personal information on tape. I appreciate the community that is willing to speak out about 1 in 4 people you may walk past on the streets where you live each day that manage and thrive some sort of mood disorder, but still having a program to not only reflect on their own actions themselves, but also be the crafters of some of the most insightful realizations about the world we live in at the same time.

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Shaping the Conversation: Designing for Family Discussions Around Aging

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Over the last eight weeks, Laura Galos and I have been working on a design solution to help facilitate the difficult conversations seniors and their families have around the major changes that come with aging.

Last quarter, we spent eight weeks conducting qualitative research with a range of individuals in their 30’s to their 80’s. We started with a focus on how people are planning for and financing their post-work years in the context of increasing longevity. The subject of aging and the impact it has on finances led us to explore how age-associated life changes also affect health and family relationships.

We found that communication about aging-related transitions can be difficult, as the older family members faces changes in the way they live, while younger family members find themselves feeling the “role reversal” of caring for the people who had previously cared for them. The communication problem families are faced with crosses a range of topics–from limiting driving, to agreement on living arrangements, to health issues, and others.

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For some families, broaching these hard subjects is too difficult to bring up until forced by external events. We wondered about the root cause of the avoidance in families. In synthesizing the stories our participants shared in research, we came to the following insight:

Elderly individuals fear asking for help because taking others’ time and resources will result in being robbed of their own independence.

We considered the need for a gentler “ramp-down” for seniors, rather than the abrupt changes that happen as a result of small problems growing into large ones. On the other hand, we clearly see a need to give the elderly as much control as possible in making choices about their lives. This was an opportunity to design a solution that allows communication between aging parents and grown children to embody more honesty, mutual understanding and a place of emotional safety for both sides.

In our exploration of the topic, we found that the journey of bringing up tough topics between younger and elderly family members follows this general path:

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We found that the journey usually begins when the family member that is responsible for caregiving, feels the need to address a tough topic. They look outside themselves for help or outside advice and will often have discussions about these issues with siblings. This usually leads to the building of a “case” against the elderly’s need to change their behavior and is followed by an intervention-like conversation that can leave both sides feeling frustrated, angry, hurt or shut down.

We see our product as an opportunity to change this journey from building a case to building understanding on both sides. Along this desired path, the intent of our product is to breaks up the conversation into smaller units focused on building understanding between family members, rather than a large conversation based on a “case” for the need to change. This likely also means that younger and older family members might having these conversations over time, rather than all at once.

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For both the younger and elderly family member, our value promise to them is this:

By using our product, we promise to help you stay on the same team as you make aging-related decisions together.

Our first iteration explored the notion of team by using game mechanics. Games allow the user to take on different roles, explore alternatives in a safe space, and have a lighter, more fun experience. They also have the ability to diffuse the responsibility of bringing up tough topics.

One of the concepts we came up with is called Balloon Bounce. The object of the game is to answer questions related to a difficult topic within a certain amount of time. Not answering the question within a certain amount of time results in a challenge that family members would complete together.

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While this idea was fun and more playful, the use of technology was more than either side wanted to take on.

Still exploring game mechanics, we still went with something that was a more familiar form. Conversation Cards. Using a question deck and an answer deck, the object of the game is to learn about each other so the answers are about the person who is asking the question. To play this game, one person would ask the question while the other players provided an answer that they think most closely aligns to the person who asked the question’s preferences. The person who asked the question would then pick the winning answer and award the person who answered with the point.

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There is a mix of fun, lighter questions, but also brings up harder questions that get the family members closer to the answers they’re really wanting to know. Users enjoyed engaging with a familiar form and coming up with solutions together. For older family members, the conversation is not centered around things being taken away from them. Because this started to get to answers family members wanted to know, we needed a way for them to follow-up on the conversation.

Veering away slightly from the game mechanics, but into that continuous conversation users were looking for, our team came up with a service called, Enveloop.

Enveloop is a web-based service that allows family members to bring up tough topics by answering prompts in the form of letters and sending them physically through the mail.

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Some users that we tested this service with liked that this allowed them to do something they felt was more meaningful for their older family member and saw this as a way to gain empathy for the changes they were experience as they aged. They liked that the technology made using the service convenient for them, but minimized it on the side of their elderly family members. Physical letters are a form they are already familiar with. Where users were less clear on the value of our service came from managing different communication methods. How would bringing up difficult topics through letters in the mail be better than talking over the phone or having a discussion in person?

The intent behind our initial design iterations was to test how tough topics could be more approachable for everyone involved. While our idea is still evolving, testing each of these concepts with users that are having or anticipate having difficult conversations about age-related life transitions in the near future, provided us with a set of criteria that will be used in our next iteration to help us move the idea forward:

  • Feels non-threatening for older individuals
  • Feels approachable to family members
  • Leads to solutions, not just fun bonding moments
  • Uses a medium older individuals already enjoy
  • Includes a way to follow-up on conversations
  • Takes into considerations families who live apart

Shaping the manifestation of this idea has proven to be as challenging as shaping the conversation between family members and the elderly itself. Quarter 3 has been as much about learning how we can make the impact we intend to have in this problem space as much as it has been about embracing where we are in the process with an idea that still exists in multiple manifestations.

Hard to believe we’re moving into our last and final quarter at AC4D. In the last eight weeks, we will pilot our idea and get our product in the hands of potential users. Check back in another week to see where our next iteration takes us!

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About being human…

This week is winding down. There has been, on my end, a lot of interaction with new technologies which I thought I could find some clarity in what I am trying to do. To bring the compassion of group therapy, through a vocal documentation of real people going through symptoms that the user of the book I am making may be going through. Things like introduction to taking medication, side-effects, stigma, and making it through the though times.

In my case, I just want to bring the feeling that mental illness is not uncommon, or weird to those who, say in rural west Texas.

So I did A LOT  of user testing this week. Hacking a Hallmark “talk to me book” was actually a good idea. My users loved it. I loved i, well I hated it and loved it. It served as a good testing tool in bringing the stories of a real humans, with their real voices, inflections, stutterers, all somehow making this thing, this book thing, like a token. Like a virtual companion. It was like turning the pages to different bits and pieces of information told from someone who is not you, but still is like you.

The addition of the human voice makes it for some reason somewhat more real. Yes there will always be a stigma around being open and honest about mental health, that may never change,  but hopefully this will help, one person seeking help for them self to get through that day, a little easier. Bringing the patient self contained technology and not relying on wifi or cell phones is both genius and problematic. You have to look at it from both sides. There is a lot of potential for technical difficulties. But this week is all about the content.

The second part is the medication regimen, this to my advantage had been just a part of everyone that I have user tested lives. From last week you know that the carrot to keeping to the regime is by taking the pill out of the container it is in the user get access to hear the voices talking about the subject that page is addressing.

I am currently working on the content, the layout, the design that make the most sense to the audience I am trying to reach,  and doing user testing along the way.

I am focussing on a 14 day program, focusing on the major pain points of a 2 week program on a new medication.

1. An introduction to the program, and an indication of how the program works, and an introduction to the “cast of characters” that the user will be hearing throughout the journey.

Here are some quick sketches, of Please, Keep Talking.

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These are very rough, as I said more clarity tomorrow. I can say this however, what has resonated as a means to mundane user testing vocabulary has almost captured the essence in which I am trying to give an bring to those who feel they are weird or alone in a vast being of scarceness and isolation to which on occasion I can totally identify with. The next step is to get into illustrator yet, I need to do more sketching I know.

 

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Better Than a Phone Call

In our second to last week of Q3, our team (Laura Galos and Maryanne Lee) continued to build out or service, Meaningful Mail (working title). This service allows family members, from the web, to introduce difficult aging-related topics with elderly family members by sending them prompts and letters through the mail. To expand on our idea since last week, we created three main flows as low-fidelity wireframes, or sketched images of screens for the web part of the service. The main flows included:

Choosing a prompt MM_Topic_2_v3_1.4.A_blog Writing a long-form letter MM_Long Prompt_1.0.D_blog Writing small sections of a letter – 2 Approaches MM_Letter Chunks_1.1.A_blog Chunks of a Letter - Approach 2 Sending a letter MM_Send Letter_1.3.C_blogWe tested these flows by conducting think-aloud user testing. Think-Aloud testing is an evaluative testing method designers use with potential users to get a glimpse into what they are thinking and having them articulate this as they are performing a task. We began testing the wireframes with users that have aging-related conversations with elderly parents or foresee themselves as being the family member who will be faced with having these conversations in the near future. The testing was valuable in that it showed us breakdowns users faced in navigating the system, but it also brought up big questions we felt we have to work through as soon as possible for our service.

1. How is Meaningful Mail better than a phone call?

“I guess just like the purpose of it. What is the reason why this is necessary or easier than just talking.” – User Testing Participant

2. How does this service work?

“I guess I never thought of anything like this. Almost like talking about these issues through the mail. Interesting. Email is more how of how I figured it would be.” IMG_0927 Because we heard these high-level concerns, we went back through our testing from the last seven weeks to make sure that further iterations maintained the most important feedback we’ve heard this quarter. From that feedback, we formulated design priniciples to guide our work moving forward.

Design Principles:

  1. Product has to feel non-threatening to aging family members, and approachable to the younger family members bringing up difficult topics.
  2. Product should feel like a 3rd party in order to diffuse the tension that comes with bringing up aging-related conversations.
  3. The directness of the conversation should be adjustable, but in general conversations should progress from lighter to more difficult topics.

Our other focus this week is in creating a value promise and checking to see if our service aligns with the promise we’re making. Today we came to this version of the value promise that applies to both elderly individuals and the family members who help care for them by listing what the utility, emotional, and behavioral value is for each party. IMG_0935_blog We are currently operating under this value promise:

By using Meaningful Mail, we promise to help you both (younger and older family members) stay on the same team as you make aging-related decisions together.

When we held up each piece of Meaningful Mail to this value promise, it became apparent that there was far more opportunity for the users of the service to collaborate toward shared goals, rather than try to find a compromise between disparate purposes. As we move forward, we will continue to iterate on each piece of the service to make sure it maintains our value promise. If we can do that, users will not have to wonder why Meaningful Mail is better than a phone call.

Our full set of wireframes can be found here.

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The Trust Engineers: Please, Keep Talking

What am I doing:

Attempting to bring the community of help to those who need it in isolation.

Rural environments severely lack the resources to treat mental illnesses such as depression and bipolar, so I am attempting to make a group therapy and medication regime delivery service. The program (so far) consists of a recordable book of stories, guided by a (recorded) facilitator that explains the program and introduces and welcomes the program to the user.  Each book page includes a longer story series the person can listen to one piece each time they take their medication. Hopefully the larger story is compelling enough that it is a motivator to keep people coming back, to stick with the medication prescribed, while identifying with the storytellers providing the idea that they are are alone, that being different is ok.

This week I have written and re-written the statement above in the attempt to make a succinct 2 sentence description of my service, but have yet to do so. So, in any case, this week I have my semi-nameless recordable book, which I am currently calling “Please Keep Talking”.

I recorded some stories. I took my dissected Hallmark book and covered each page so I could begin to write and record my own story. I ordered electronic recordable equipment from Amazon for later use. I integrated my facilitator script, and recorded stories into my book with a “fake” peel-able blister pack for each pill that will expose the sensor to light and thus trigger the story.

Tomorrow I am testing what I have, by showing it to some folks here in Austin, and then next week (or later this week) getting this book in the hands of a person/s a little closer to the demographic that I am specifically targeting. Perhaps just heading down to Dripping Springs or Wimberley and asking people what they think. The opinion of an individual dealing with a mental illness in a city may be drastically different from someone in a rural or isolated environment. And I NEED to know

Something that might be an iteration for Q4 is the possibility of scrapping the daily series, extending the program to 30 days, and giving access to the full story up front with the “carrot” to refill your prescription and get a new story for the month. This was an insight brought to me by a new friend I have been running ideas by who thought that might be an alternate solution. Basically, keep it simple, and keep it real.

I’ve been interviewing and getting feedback this week about my “thing” from real people with real ideas, even on who and how to test an actual get my prototype in the hands of say a small town pharmacists to hand out to a personal connection, and somehow get feedback on usage and what they thought about content and if the technology worked.

There are a lot of what if’s to my isolated technology. The technology in a box could… get wet and die, it could get stepped on, it could just not work at all. It could also violate HIPPA regulations to which I am currently adamantly researching because that is certainly nothing that I wish to do in any way.

Please, Keep talking – a book of shared stories from people with mental illness, including information about how important medication is and how to deal with side effects and how to get through the tough times, is 99% complete.

Now I just need to see what people who will be using this actually think of this idea. User testing even in this context seems like an odd choice of words, but it is true, and it is research; however I would like to think of more as interaction observation taking vigorous notes on subtleties individuals may not say with their words but with their actions.

And iterate from there…

Please, Keep Talking – a study on the power of narrative/medication with individuals living with a mental illness

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So my new buddy recently shared with with me a quote that he thinks about a lot, about his battle with mental illness and his, well just “being” in society.

That ‘In this life all you have is this moment. Despite all of the stresses and pressures the only thing that matters is this, very, moment. An the best part of life is that by living in this moment you can actually acknowledge and change that person you want to become…”

Personally this sounds very difficult because I am always thinking a million miles ahead, but I get it. And I empathize. And I iterate.

 

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Diagnosis : The Chemistry of Affliction

What is your diagnosis? What is one good thing that happened to you this week?

That is how where my story begins – today.

In doing my prototype testing and scenario validation, I have been getting close with a group of folks. The people change week to week but the introductions are always the same, the explanation of what is to come is always the same. That is comforting in a way. A re-enforcement of some stability or normalcy before the next 2 hours of guided sometimes hard to hear, dialogue. I ask questions, and feel really grateful to get honest answers to my questions.

There is a relief that I have observed from people hearing other people’s stories, however mundane. Even if it is just about what the best meal they ate that week comes. There is a sincere connection from individuals who really do not know each other at all outside of the context of that room.

So again, where is my project my “thing” today? Re-capping from last week when I scrapped the concept of the advent calendar, and decided to test out my book of stories and activities that revolve around adherence to a medication program. I made some scenarios, and I showed the book to a few people and got some feedback that “man, that is a lot of words, and a lot of writing”. Which got me thinking yeah… the people that I have been interviewing and working with for the past 3 weeks who may not be able to get out of bed for a week, and who haven’t even been able to have a job for years might not be into.

When you are in a state of being down, from my personal experience even, I don’t want to do anything. I want to watch TV, I will listen to Radiolab for hours but I can’t read, I don’t want to read. I may want to write but I actually asked the question in my last session how the group felt about “homework” and WOW the reaction was f-no I’m not doing homework.

So that a little bit blew my “fun activities” along with stories as therapy for people with mental illness in west Texas needed to evolve.

How do you get the warmth of the sharing stories with another human in a totally individually packaged analogue package.

Pat, a professor here at AC4D threw out the idea of those talking greeting cards and EUREAKA! I can do this! I can bring the technology to the patient. Rather than relying on the assumption that someone possibly in the middle of nowhere has high-speed wi-fi or even cell phone connection, or even a TV. I can use these little devices to bring a persons story into their home.

So I rush out to destroy some Hallmark “tell me a story” books and recordable photo frames and greeting cards and began figuring out how they worked. The book is quite clever, it works by a series of light sensitive triggers that when exposed will playback a pre-recorded story. A different sentence by turning the page and exposing a new sensor to light by a hold in the side of the page.

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The card and the photo frame works by pressing a button to record, and then another button to play.

This week is a week of discovery. I want to introduce to isolated individuals the same feeling of being in a space with others like them. To use these technologies to connect perhaps someone alone in west Texas the opportunity to hear the stories of others from their mouths, with their inflections, stutters, hesitations and emotion to connect them through voice, with a little widget that cost probably 2 bucks to build.

This week is a week of definition of purpose, of order and specificity of content, iterating the medication regimen in the narrative, and finding that carrot that keeps the patient going. That keeps them excited about following through to the end. The book is still my book, just being spoken to the patient rather than the patient having to read the story themselves.

Activities for the week:

  1. New scenarios with this technology integration.
  2. Test scenarios.
  3. Develop a succinct description of my service.
  4. Plan out content in order or appearance.
  5. Play with technology.
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Learning from digital to create smart analogue: Where does the warmth comes from?

I have recently been struggling with the idea of simply making things that exists purely on a screen for the rest of my life maybe isn’t really what I want to do.

I grew up a painter and a dancer. For christs sake I got a blowtorch for my 12th birthday and started fabricating those cool little lampshades that teeter on the edge of a pin, circling slowly as the bulb from the light gets hotter and hotter. I created my Frank Lloyd Wright dream house out of an old box I found one day after school, with this crazy roof that looked like the peak of a Rocky Mountain AFTER running home to watch Bob Ross teach me how to paint happy trees.

Where am I going with this?? I know, I know I promise there is a point, and an epiphany of sorts. And it involves the inevitable connection of digital and analogue.

But first, I would like to introduce “The dawn of Midi”

A band existing between the intersection of analogue and electric sounds. Played live, and 100% acoustic, with patterns of sounds that if you tried to dissect each instruments noise individually, you would realize they are not really fitting together. They just sort of exist in their own rhythm and tempo.

But when you take a step back and soak it all in, these… noises come together to create something beautifully cohesive. The sum of it’s many very different parts actually have a point. Hearing this band, (which completely sounds electronic by the way) made me start thinking of how many things we have actually pick up from technology to make really cool analogue.

Now, as an analogue girl livin in a digital world, I may not always get that warm fuzzy feeling from something digital like I may from something tangible. It IS possible.

Don’t you want to think so? Doesn’t every interaction designer want to think so?

Now days there is no escaping the one from the other. Even most of the time in order to make many of these “things” that I am talking about first begin with the inspiration or even the use of some digital technology.  I make a box – I design it in Illustrator and print the cover on a wireless printer. Or I make an interface, and the design begins by introducing a full screen-moving image of an actual human in nature.

So dorking out a little and thinking of the notion of digital v analogue. In reality…no hardware is truly “digital.” All of it incorporates some amount of analog circuitry, for one, and it’s also the sum total of many many design decisions.

The fact that we think of computers as not having physical interfaces is perhaps itself a critique of the physical interaction design of computers themselves – we’re in a way so used to the mouse and keyboard that we may forget we’re having a tangible experience at all. Unless it’s a really bad one.

The advantage of interaction design can be to remind people that it is ALL an experience. The really good ones can take something digital on a screen, and make a person feel something human, something truly analogue. While something completely analogue may reach a person on an emotional level through touch, imagery, color, fonts and interactions inspired by, and prototyped with technology.

This is the part where “the point” comes in as promised. Good design is complex. Great design will always involve some sort of process that combines analogue and digital. Whether it is sketching, or storyboarding, or brain dumping on a whiteboard.

In conclusion… my fear of falling into a cold dark digital world can be tamed.

So hug your computer today. Then go make something.

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User testing and observation

After creating my “Thing” which I describing now as a journey kit for individuals diagnosed with a mental illness focussing particularly on the various ranges of depression, to bipolar, and anxiety disorders.

My first round of user testing was incredibly enlightening and educational. My assumptions that something playful and interactive proved to be a bit too foreign and confusing to my users. No one came out and directly said that, but by reading facial expressions and their interactions with the kit, I could tell that the whimsey surrounding the idea may have come off as not taking the user seriously.

Before I go any further I will introduce first the journey kit, in a very rough prototype that I tested with. Then the series of questions I asked, what I learned, and how I am currently moving forward.

The kit.

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I should say first that as I passed around the kit, I also passed around a potential user scenario in that described what it might be like if your Dr. gave you this thing rather than a bottle of pills. This scenario was accompanied by a one frame image of a woman being handed this box:

IMG_4281With this scenario:

“Jane has just been diagnosed by her psychiatrist as having major depressive disorder. She has been feeling overwhelmed yet hopeless for a while now, so the psychiatrist has suggested that she try out some medication as well as her therapy immediately.

Jane is pretty anxious about taking medication. She has heard a lot of horror stories of side effects, or the zombie effect, but at this point she is really just looking for some relief so she is willing to try anything.

Jane goes to the counter of the psychiatrist office to check out and is surprised when instead of the dr. giving her a sample pack or a bottle of pills she is handed a box.

All that the box says on the top is “Hello. I am here to help”, she is intrigued as to what could possibly be inside. But also confused, “Is this medicine?” she thinks.

The dr. explains that this is a starter kit for her. That having a diagnosis of depression is not the end of the world, getting to a place of self-acceptance is a journey and she would like her to give this kit a try. If the medication and kit process is working for her she would like to keep her on the program, and validates that she is not alone. She is here to help.

She explains that inside she will be guided through the process of taking her first week of medication with this kit. Inside it has day-by-day pull out pill packs, like and advent calendar, clearly labeled “Day1, Day2 etc.). There is her phone number inside the inside cover of the box if she is experiencing any side effects or just needs to talk her number is always there, and on the 4th day she would like her to use the included pre-posted notecard to answer 3 simple questions about how she is doing and mail it back to her so she can keep in touch when they are not face to face in a therapy session.

She also explains that inside there is also a book called “My Story” that has stories of people just like her she can read, and blank pages where she encourages her to write down her story, and to record her thoughts or feelings each day in the “My Story”.

She describes how to take the medication and tells her that the instructions and info about the medication is on the bottom of the box if she ever needs it.

Jane thinks to herself, “my this is different. I hope I can keep up with it all this”, but is uplifted a bit that she is not just being sent home alone with a bottle of pills. ”


This activity was followed up by a short questionnaire regarding the accuracy of the scene, if there was anything that would make the concept more relevant, or more simple, if there was anything missing, and what might you do to improve up it if you could do anything.

The answers were group based, and was a very enlightening discussion.

One woman – age 54 – described the scenario as being seemingly accurate, but definitely hopeful that the Dr. would guide her through the process of using this “thing” because there really was not much direction in the prototype. Rather intentionally actually, a choice made by myself to try to be very clear yet still have a sense of discovery.

Another man – age 47 – thought it was an “interesting” idea, that the postcard was nice, but really the action of taking each pill out of the box, ripping it off of the card and taking it with you was a bit unrealistic and tedious.

My sessions are so far being held in a medical facility where you are not even allowed to bring in your phone, but one man was nice enough to go out to a cafeteria and fill out his scenario there.

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So with what I observed, listened too, and got in hopefully honest writing was that I need more focused content.

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What I came out of my session was this:
People WANT to tell their story. Affirmations are nice, but the content needs to be packaged more familiar, and the actual content needs to better encourage a few key items.

  • The idea that they are not alone.
  • That they are not weird.
  • That other people share their same story.
  • That the idea of being “normal” is such a stretch perhaps it is more of an acceptance that not being normal is really ok.
  • People rely on their medications, and switch meds a lot until they find the one that works for them.

GOING FORWARD:
The box is staying. The innards are changing a bit, but really just becoming more robust around the narrative listed above. I am now moving forward with the “notebook” kit rather than the advent calendar approach, which I believe will gain me more access to be able to provide guided content, as well as it being a much more familiar and portable solution for people who may need to have their medications with them on the go. I am now focussing on a 2 week solution rather than a one week solution.

The week is moving fast, I just got my second round of just feedback, no scenarios, from a few new people that I will share next time, and hopefully have more people to comment on the actual included narrative of the item, as well as the construction – next week.

 

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Mental Healthcare: Creation Continued.

This week was a week of reflection. It was time now to take all of the information that had been gathered. Print out all of the photographed whiteboard diagrams and scenarios, and do another round of synthesis on these new artifacts.

I had to take a bit of a step back from my initial design plans and start to really focus on the narrative around the product, which will inherently determine the way the product is designed.

Just to re-cap for a moment. I am working on developing what I am calling a “Journey to Recovery”. I have yet to even begin to think of a catchy 2.0 name and am very cautions really when it comes to putting a label on my service product because of the nature of the content.

My problem opportunity is this; I have backed up research and data that suggest that a combination of both therapy and medication are the best tools for helping an individual suffering from a mental condition.

That statistically 30% of individuals prescribed medication for such things as depression or bi-polar disorder never refill their first month. I was informed from an individual source that their particular center experienced only a 1% success rate or people making it through recovery and into self-sustainability.

Because I am focusing on areas where there may not be access to therapy or possibly even a support system for miles and miles, I must attempt, before even thinking of packaging design, to put myself into the shoes of my potential user. Where they come from. What they may be familiar with, and unfamiliar with as well. How to be cautiously empathetic without at all seeming contrived or like an “out sider looking in”.   

I took this week to really stop and think about what it would be like to receive a package of some sort, in the mail, that was intended to both inform, guide, provide medication instruction and expectations, provide support, and connect me to the outside world.

What do I see when I open my mailbox, visually? What does it feel like to receive a package in the mail? What is physically printed on the outside?

What indicators are there that tell me how to open the package? Am I confused? Do I say to myself, how do you work this thing?

When I open it what am I encountered with? Am I intrigued, cautious, welcomed, or encouraged? Am I relieved?

At what point am I presented with the concept and actual physical visual of the medication, and how might that feel? Do I feel anxious, or skeptical? Is there anything that accompanies the idea of being medicated long term that makes me feel less… broken?

How do I get the medication out of the package? Do I have to work for it? It is easy? Do I have to read something or interact with the package first before I can access it? Are the instructions clear? Day by day, hour by hour if necessary.

Lastly, when am I presented with opportunities to reach out to others, to mail back a letter, or call a number? And do I get a reply back? What does that feel like?

I am currently in the process of sketching and iterating upon those sketches with more sketches as well as working on researching comparative analysis on not to name names, but some pretty horrible products out there in the pharmaceutical land that actually gives me encouragement that I might, possibly be able to make some positive effect on someone. Someday.

Below are the questions posed above, in sketch form, mapped out as a step by step experience of what it might be like to interact with this thing.

 

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Now is an iteration 1 of an advent calendar style box that carries 6 weeks of medication, that encourages playful interaction, encouraging and identifying stories from people in the same position, with an intervention mail in card placed after a few days that the patient interacts with (fills out their story, scratches off how they are feeling, possibly suggests that they reach out to the center writing on this card with something they feel they need, such as more support). Each advent type small box holds 1. a card that can be taken with the patient, put in their pocket etc. 2. Encouraging narrative quote pertaining to the day the patient is on printed on the inside of the box opening, and 3. the actual medication packaged in a way that is easy to access for someone who may be elderly or lacking fine motor skills.

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The the process starts over with the next day.

Iterations 2 and 3 follow the same guidelines. One being a booklet shown here below, and another still in progress more of a travel kit.

The front of the booklet will follow along the same guidelines as the advent calendar idea. With familiar imagery, possibly a landscape, brand name, and indicator to open the package. My visual inspiration is from this package which I find universally soothing and very in touch with nature or a rural setting in a non condescending way.

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The booklet goes as follows:
Here are both the front of the booklet as well as how the basic structure is to be laid out. If it is not super clear, the booklet will contain 14 pills, 2 weeks of medication, in a semicircle pattern. With die-cut pages revealing the pill of the day along with varying narratives, resources, and stories.

- Basic structure:

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1st page welcome message / what to expect / Congratulations on taking the first steps to recovery:

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2nd page, clear messaging on the day, a narrative of someone in a similar situation, encouraging imagery and affirmation and a die-cut of the medication that is a blister pack you push through the back to access.

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3rd page similar to the 2nd, but with varying narrative as to remain fresh and interesting, the patient can see their progress by the 1st day of medications die-cut still there but now filled with a bright color:

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Intervention page: A tear out foldable pre-posted card that inquires about the patients status, wants and needs. Suggests ways to reach out for help, and resources available. Encouraging to stick with the program, that it will get better, and to notify their therapist if they are experiencing any ill effects at all.

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I have purchased the supplies to begin building more formal prototypes to test this week, and am currently working on refining the initial narrative that surrounds the recovery journey experience.

 

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Mental Healthcare in Rural Texas: Interaction design for the people, by the people – that have no idea what the people need

It’s true. I would imagine the majority of projects that an Interaction Designer works on are for people they may have never met, and have no idea what their users need or the processes they take to meet their needs. This could be true from anything as simple as re-constructing a bus system app if the Interaction Designer has never ridden a bus, or as complex as attempting to create, through design, a solution to the wicked problem of access to mental health care in rural America.

The latter of the two examples is what I am focusing on, and have been for the past 16 weeks or so.

This initial blog post is the beginning of a series of stories. Intended to serve as an overview of the backlog of all the travel, research, data synthesis, and real user scenarios (names changed) that I have gathered and now currently processing out design ideas. We will identify the key players, the where, when and how they go about meeting their needs. As well as the obstacles and challenges both the patient and the caregivers face in their journey through the difficult process of both access and care.

There is a lot to catch up on, so let’s start from the beginning.

I began my research focusing solely on access to general healthcare in rural America.

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I was drawn to subject this initially because of my own upbringing in extreme rural Texas. Where the nearest hospital you could visit for anything more than vaccinations or stitches on your knee after falling out of a tree per say, was about an hour away. During my contextual inquiry, where I went to a rural Texas town, investigated their medical facilities, and interviewed both physicians, caregivers, and patients, interviewing and observing them in the environments where they lived and worked; I actually realized a larger problem than access to general healthcare was access to mental healthcare. And in rural Texas, as well as the rest of the rural United States, access to mental health care facilities I found to be tedious, illusive, and sometimes non-existent.

For most of us access to a therapist is relatively simple. The person reading this, myself included, may know a handful of psychiatrist or psychologist that can be accessed for an appointment during their lunch hour. In extreme rural areas however where the majority of the people are either on Medicare, Medicaid, or fall between the coverage gap of not being poor enough to qualify for Medicaid, and not being old enough to qualify for Medicare, are directed to privatized mental health centers. These centers are few and far between and operate on grants, donations, and the kindness of wealthy philanthropist to provide therapy and medication to those in need.

However, there is a catch. In order for the center to pay for the visit and the medication the patient has to actually be physically present in the facility AND rather than being able to speak directly in person to a therapist, the diagnosis is done via teleconference. This means that the patient must drive, sometimes up to 3 hours to visit the center (walk ins welcome) and talk to a TV screen.

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This in and of itself is barrier number 1.

I had the opportunity to interview a caseworker that had just retired from one of these centers and from that interview a number of insights were gained as well as some very compelling stories. She was able to give me information about the patterns she witnessed in her 14 years of service.

That there is a stigma around seeking help for mental health issues, most likely shared throughout many societies but specifically in an area where “everyone knows everyone’s business”. There is a perception that you should be able to suck it up and it really takes loosing it all and hitting rock bottom for individuals to seek help. This generally happens when their personal support system has been tapped out. They feel alone and the final option is to drive, once again, to a clinic far away to speak to a psychologist via teleconference.

Another issue in very rural areas is access to technology. During the course of my research I personally had zero cell phone service, and admittedly drawing from assumptions, many of the homes in the sparsely populated areas looked as if they did not have running water let alone wifi.

And then there is the glaring isolation. Homes in the areas I visited are sometimes miles apart. There are “towns” I put in quotes, that really are just a few households spread out on a large piece of land. Some having populations of just 100ish people.

A number of publications I found had done intense research on this very topic, thus validating that this is not just a personal problem it is a problem that affects society as a whole. One paper entitle “Mental Health in Rural America” illustrates the shocking statistics that were uncovered in their research.

[excerpt]”In a review of studies investigating the prevalence of psychiatric disorders in rural primary care settings, Sears and colleagues (2003) found that 34 to 41 percent of patients had a mental health disorder. Additionally, results of studies of seriously mentally ill individuals indicate that rural residents have poorer outcomes (e.g., reliance on inpatient services, increased symptom severity) when compared to urban residents, especially if there are co-occurring substance abuse issues (Fisher, Owen & Cuffel, 1996; Rost et al., 1998).

One striking difference between rural and urban populations is the higher rate of suicide in rural communities, which has been a consistent trend for more than a decade (New Freedom Commission Subcommittee on Rural Issues; NFC-SRI, 2004; Institute of Medicine, 2002; Stack, 1982; Wagenfeld et al., 1994). Specifically, the suicide rate for older adult (elderly) males and Native American youth in rural populations is significantly higher than in urban populations (Eberhardt, Ingram & Makuc, 2001).

Adults suffering from depression, who live in rural areas, tend to make more suicide attempts than their urban counterparts (Rost et al., 1998).”

This is a real problem.

So after weeks of contextual inquiry, transcription, secondary research gathering and synthesizing out all this data I could, I then began developing some insights into what this all meant. There are some serious problem opportunities that could be addressed.

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Questions I asked myself along the way:

  • How can a center stay connected to their patients and monitor their mental state and medication regimen after they walk out that door?
  • How can any tracking or monitoring of a patient be performed without seeming clinical or cold?
  • How can a support system be established for patients that are isolated?
  • How can technology be taken out of the picture and a program still work?
  • How can I actually get a patient in this environment in a particular mindset to even care about following and participating in a program?

I went through a series of many many brain dumps of potential scenarios, at least a hundred design ideas. I concept mapped, and process flow diagramed a few I thought were potentially viable. Threw those out and started over again. I did storyboard after storyboard attempting to validate through real life scenarios of how some of these ideas would play out, and finally landed on one over arching theme.

What I am currently iterating on is a Patient Journey Kit that utilizes Fed-Ex or the postal service rather than a smart phone or a computer.

This kit will be packaged with their medication, and seeks to guide the patient through the process of self-recovery week by week.

I would like to include:

  • Real stories from real people expressing their experience, a new story each day/week that hopefully identifies to the patient that they are not alone. And what they might be feeling is not shameful or wrong.
  • An encouraging progress tracker, that provides information about how the patient may be feeling taking their medication, so there are no surprises and empowers the patient to be aware of their mental state.
  • A tear out and mail back interactive questionnaire that does not feel like a questionnaire but more like a personal check-in. It will be mailed to their caseworker, pre-posted with the name of the caseworker and address pre-filled for the patient’s ease of use.

I currently have about 6 iterations of how this could possibly play out, and how the system logistics could actually work.

Next steps include more sketching, more scenarios, and narrowing down to at least three rough working prototypes to test with both therapist and patients this week.

I am very excited about this project moving forward. The following post will include status updates of testing results, iteration prototypes, and new insights I gather along the way.

I would like to hear from you! All information is valuable so if there is an opinion or comment that anyone would like to share to benefit or critique the project I encourage any and all feedback.

Thank you!

 

 

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