1-2-3 Device Redesign 

CLIENT

Cincinnati Children's Hospital: Cancer & Blood Diseases

MY ROLE

UX Design Fellow, Researcher, & UX/UI Design Lead

TIMELINE

May 2019 - April 2020

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OVERVIEW

What Is The 1-2-3 Device?

The 1-2-3 initiative was developed in an effort to reduce infection rates and help patients manage their own physical activity and hygiene. This project was founded from a nurse-backed incentivized program that awarded stickers to patients who completed three activities of daily living (ADL’s). These ADL’s include bathing once, doing physical activity twice, and doing oral care three times hence the naming of the 1-2-3 Device. Stickers were exchanged for “BMT Bucks” which could be used to buy toys from Child Life. 

 

The 1.0 device was developed to help automate this process for Bone Marrow Transplant (BMT) and Cancer/Blood Disease (CBDI) patients. Patients use the device to log these activities and keep track of points awarded for completion. RFID cards are swiped by patients for logging activities, and parents and nurses use their RFID cards to verify points. 

OVERVIEW

1-2-3 Device 1.0 Version

The 1.0 device with family/caregiver RFID card before the redesign.

OVERVIEW

Defining The Problem

While the 1.0 device improved on overall patient adherence, it was difficult and time consuming for nurses to manage, lacked a deeper sense of patient motivation, was difficult to upkeep, and required more advanced functionality and hardware.  

OVERVIEW

Project Goals

01

Understand experiential deficiencies of the 1.0 device and identify opportunities for improvement. 

02

Develop a deeper understanding of what motivates patients to increase their compliance.

03

Design a V 2.0 with improved interaction, usability, and experience.

RESEARCH

Research Methods

A

Incentivization in Pediatrics
Goal: To better understand precedence and existing research on the relationships between incentivization, motivation, adherence,  and/or habit-forming behavior 

Methods: Literature Review

B

Investigating Relationship Between ADL Adherence and Bloodstream Infection, Prolonged Hospitalization, Pressure Ulcers and/or Therapy Schedules
Goal: To better understand cause/effect of ADL adherence

Methods: Analysis of historical data of BMT and Oncology patients ADL adherence

C

Education Program
Goal: To better understand the current educational program regarding Infection Prevention, ADLs, and Adherence

Methods: Collect and analyze existing material. Consider communication platform (“Infection Prevention Therapy”) Interviews with Healthcare Staff and Care Team memb

D

ADL Adherence Digital Application
Goal: Determine if/how a digital application could help certain co-producers improve ADL adherence

RESEARCH

In-depth Interviews

CCH Technical Leads

CCH Project Managers

CCH Clinical Research Coordinators

CCH  Nurses

Patients & Parents/ Caregivers

RESEARCH

Insight Collection: Patients and/or Family Caregivers

Looking at what patient/caregiver motivators and barriers exist for each activity of daily living

RESEARCH

Insight Collection: Healthcare Professionals

Looking at what staff barriers exist for each activity of daily living

RESEARCH

1.0 Device Interaction Map

 

This map outlines every daily expected interaction with the 1.0 device as well as the pain points and opportunities areas for improvement. We learned that the 1.0 device requires far too much redundant interaction for nurses and families to maintain, which often left patients waiting for point gratification. 

RESEARCH

Insight Collection: 1.0 Device Deficiencies

A

B

C

D

Nurse Workload 

  • Nurses are often understaffed, work irregular hours, and extremely busy; making it difficult for them to remember to interact with the device and authorize points.

  • Nurses are more focused on procedure, so the device is considered low priority in their eyes. 

Patient Motivation

  • With a wider range of ages admitted to the hospital (babies to 20’s), motivation differs greatly.

  • Being motivated by an extrinsic system of exchanging points for prizes is not actually very effective since patients are consistently getting toys during their stay anyway. 

  • Interaction with the device is redundant with little immediate payoff.

System Upkeep 

  • The prize management significantly increases workload for staff.

  • Swiping the RFID cards is burdensome due to cost, connection issues, and constant swiping. 

 

Function & Hardware

  • Overtime, the interaction with the device loses its appeal and novelty, and becomes forgotten.

  • Parents and nursing staff are more concerned with the overall trend of how patients are performing rather than the day-to-day details.

  • No way to access any kind of data summary to track decline or improvement.

  • Current design limits adherence to only the three core activities.

  • Interface graphics require continual replacement due to constant disinfection.

RESEARCH

Personas: Patient Persona

RESEARCH

Personas: Parent Persona

RESEARCH

Personas: Parent Persona

RESEARCH

Personas: Nurse Persona

RESEARCH

Incentivizing Patients: Gamification Strategies

Gamification refers to a process of using gaming elements in non-game conditions with a purpose of reinforcing positive learning behavior. Technique has been successful in industries as varied as personal healthcare, retail, and education. 

 

  • Goal: Find evidence based insights into youth incentivisation/motivation to guide ideation

 

  • Action: Game based interaction tools using different gamification strategies

RESEARCH

Incentivizing Patients: Gamification Strategies

Competition

Avatars

Time Pressure

Choice

Story

Quizzes

Challenges

Strategy

Consequence

Choice Criteria

Intrinsic Motivators

Positive psychological behavior

Age accessibility 

Complexity

Time

Virtual Economy

Loyalty

Personalization

Growth

Community

Collection

Badges

Status & Envy

Leaderboards

Incentivizing Patients: Play-based Prototype Evaluation Methodology

RESEARCH

Controls

Theme: 

Space

 

Concept Delivery: 

Board game

 

Task: 

Math flashcards

User Population

12 Children

 

8-12 Year Olds

 

4 Males

8 Females

Evaluation Tools

 

Motivation Questionnaire

In-game Observation

Post Game Exit Interview

01

Play-based Prototype | Space Rescue Case Study 

Game Elements

  1. Competition 

  2. Time Pressure 

  3. Personalization

 

Insights 

  • Engaging at the start but may get repetitive after the excitement begins wearing off. 

  • Time pressure adds urgency to task completion.

02

Play-based Prototype | Storm Escape Case Study

Game Elements

  1. Story

  2. Choice

  3. Strategy

  4. Consequence

 

Insights 

  • Choice & control are strong motivators for users at this age.

  • Consequence increases personal investment because it shows your actions have repercussion.

03

 

Play-based Prototype | Moon Base Builder Case Study 

Game Elements

  1. Virtual Economy 

  2. Growth

  3. Personalization

 

Insights 

  • Virtual economy works well when paired with personalization. 

  • Personalization was a familiar concept and a strong motivator to this age range.

  • It’s important for users to know their actions make impact on the system.

04

Play-based Prototype | Planet Collector Case Study 

Game Elements

  1. Collection

  2. Badges

 

Insights 

  • Badges acted as positive visual representation of overall progress.

  • Motivation is more effective with multiple game elements combined (in comparison to space rescue).

RESEARCH

Incentivizing Patients: Key Insights

01

It is important for patients to know their actions have an affect on the system

02

Patients need a visual representation of growth and improvement 

03

The learning curve must be balanced for ideal engagement

IDEATION

Wireframing

IDEATION

User Testing: Draft 1

6 Users Tested

An avatar concept was originally proposed by nurses so it was well received when testing with staff; however when testing with older patients (teens), they felt it was too childish for them.

 

While younger children would use the avatar, we didn’t want to alienate older patients who could benefit from the device. The goal going into a second draft was to refine the less intuitive interactions and develop a new UI that appeals to a wider age range of ages.

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IDEATION

User Testing: Draft 2

10 Users Tested

While overall usability was successful, there were mainly issues with the overall concept of verifying points. Nurses felt that being part of the verification process was unnecessary due to their already large workload.

 

We also discovered that not every child has a consistent family member to take part in validating points. Nurse and family members were mostly concerned about the patient’s overall adherence trend rather than day-to-day interactions.

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REFINED DESIGN

Main Dashboard UI: Activity Entry

REFINED DESIGN

Positive Reinforcement: Gamification of Activity Entry

REFINED DESIGN

Edit UI: Customizing & Editing Activities

REFINED DESIGN

Data Visualization UI: Progress Tracking 

REFINED DESIGN

Mobile App UI: Remote Caregiver Access

My Role and Responsibilities

  • Formed project goals

  • Conducted stakeholder research

  • Developed personas

  • Identified device opportunities

  • Designed wireframes and information architecture

  • Independently developed the UI styles for the final designs

  • Led the design for the device interface and formatting of device UX

  • Independently led creation of Invision Studio interactive prototype

  • Conducted usability and research testing with nursing staff and patients Presented findings to key stakeholders and client directors

Key Learnings and Reflection

In this project I developed a deeper appreciation for the value of user testing. The target group consisted of children, parents, and nursing staff, so there was a wide range of ages, needs, and education levels to consider during the design process. Due to the variation of user conditions, it was important for me to let the testing results and feedback guide my design decisions. One example 
of how user testing helped in developing a more valuable product was how the insights the team gathered from nurses became a big influence on the outcome of the data visualization. In the early stages of the project, I assumed nurses would want to be very involved and would appreciate a more detailed and comprehensive data history of the patient progress. However, after testing a few concepts with nurses, they expressed that they had very little time to interact with the device and they were more interested in visually obvious and quick to understand data feedback. Based on this information, I designed the data feedback screen to give nurses more of a data overview of where patients were succeeding or declining as well as a visualization of the progress trends for the week and month.

Project Team 

Interface & Design 

  • Ariel Swift: UX Design Fellow: Interface & Experience Design Lead  (full-time 1 yr duration of project)

Research & Ideation

  • Ariel Swift: UX Design Fellow: Research & Ideation (full-time 1 yr duration of project)

  • Todd Timney: Faculty Research Fellow: Research & Ideation (full-time 1 yr duration of project)

  • Kellen Crosby: Biomedical Engineer Co-op: Research & Ideation (1 full-time & 2 part-time semesters)

  • Jay Hayne: Design Fellow: Research & Ideation(1 full-time semester)

UX/UI Designer, Strategist, and Reseacher 

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