Supporting Caregivers
through education

The Problem

May- November 2020

UX Researcher | UI Designer

Caregivers are generally overworked and unappreciated. They often work 24-7 to care for aging and/or disabled patients. It is a physically, emotionally,  and mentally demanding job which they do out of duty to give the best care to that patient. Rarely are caregivers or their patients provided proper training on how to use the equipment safely. In addition, they are seldom  advised on which type of equipment is best for the patient or their given condition.

The project began in May with an idea that started out as being telehealth education. It was developed using the five-step design thinking process of empathize, define, ideate, prototype, and test. The project included research, iterations, designs, more iterations, and ended in October with changes made due to the feedback during the usability tests.

The Solution

Design thinking includes four steps in the process that include: Empathize, Define, Ideate, Prototype, Test (and repeat) which I applied in creating an application that would be best suited for the users (in this case, caregivers). Because of the iterative nature of design thinking, it allowed me through the process to see the problem more clearly, seeing that the original problem was not the problem that users needed solved. In this project, because the problem changed, it was necessary to do further research in empathizing and defining. This Image, courtesy of the Interaction Design Foundation, shows the process of iteration very clearly:

My Assumptions

To understand the problem, (which initially was regarding telehealth education for nurses), I interviewed 6 nurses to understand what they were going through and what they needed in their job to be better educated on telehealth. After conducting the interviews, creating affinity and empathy maps,  and creating personas, I realized that the problem was not that nurses weren’t educated on telehealth (which may still be a problem, but not the central problem for these nurses). The problem for them was how to disseminate massive amounts of resources on Covid and telehealth. What they needed was a curated resource to learn about what was happening with Telehealth and Covid, not telehealth education The data was also showing that the more urgent need was to care for these caregivers, who are working 24/7 to care for disabled patients, and to support them in their daily lives.

What I found was that although the nurses did not have a common theme of education, I realized I had assumed due to my prior experiences with telehealth. I had spent 3 years researching telehealth, with one area being telehealth education. Unfortunately, that was not what the nurses needed. 

Realizing that I was wrong on what nurses needed, allowed me to see that caregivers were the forgotten population.  

Initially it was still a telehealth issue, until interviews with caregivers revealed that what they needed was understanding mobility equipment. 

A Shift to Caregiving

Further interviews were conducted with caregivers including family caregivers, hired help, and family members paying for help. I heard stories of their struggles and injuries that incurred as a result of improper training of mobility equipment.  

The personas were readjusted to include two main personas, eliminating the nurse, due to a shift in direction. This first one is on the family member  “Mary” paying for care, and the primary user. The second was the family caregiver.

Five interviews were conducted with family caregivers (those that did the caregiving) and five more were those family members who had an outside job and hired caregivers to care for their loved ones.

User interviews revealed that when it came to mobility equipment, they had the following characteristics in common:

• The difficulty of finding good help, 

• difficulty in lifting, 

• stress levels of being a caregiver, 

• and lack of training/knowledge in using mobility equipment

•  or knowing which type of equipment was appropriate for the patient.

After conducting interviews with caregivers, personas were created. It was revealed that the real problem was that caregivers were not supported in their role.

Personas

“Jane” is the family caregiver who has sacrificed her life to care for her family member. The love of the family member she is caring for is important and “wants to give the family member freedom in their healthcare”.

“Mary” is the family member who is paying for care. Because she has a full-time job is not able to give 24/7 care so hires outside help. She “wants to hire the best care for her family member so that they are happy and safe”.

After the empathy maps, affinity maps, and personas, the definition stage began with How might be statements. It is through this process that I began to understand what the problem was and what the users needed.  Although other How-might-we (HMW) questions were posed, these two questions relate to this problem specifically:

• How might we create freedom for caregivers so that they are able to care for themselves as well as their patients?

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• How might we provide equipment training for caregivers so that care-workers can lift patients safely without injury to self or patient?

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Because the bigger issue was on safely using equipment without injuries, the second question was the focus, where the first question is a possible version.

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From the HMW statements, I conducted an ideation exercise, which helped me come up with several potential options for each HMW statement. Although some ideas were more tech-savvy and progressive, the user is kept in mind when choosing the appropriate options for them.:

In this  ideation exercise, I explored very technological advanced ideas to more simplified ideas with video training, articles, and a chat box.

Although the ideas were interesting and some were relevant, some were not appropriate for caregivers, who tend to be older, and less tech savvy. The next part in the definition stage included user stories:

User Stories

In the user stories, returning and new caregiving options were given with their goals of learning about new patient mobility equipment.

In this image of the user stories, I included the Importance (those items that need immediate attention)(y-axis) and Urgency (those items that contribute to the long-term goals, values, and mission)(x-axis) scale, where mobility equipment was both on the importance and urgent scale. Mood identification options are not as important or urgent so are on the bottom and should there be development beyond the first version, it would be developed later.

User interviews revealed that caregivers are usually older with less tech savviness. Therefore it was important to be simple.  

Steps to creating a prototype included a sitemap and wireframes of the red routes, the main routes that a user goes through in the process of navigating the app

The site map below shows the type of equipment from the home page is available and the other options for types of equipment. Wheelchairs were chosen as the MVP due to the urgency and condition of the patient. The wheelchair was reported as the most difficult in using and transferring from, as revealed in the user interviews. The MVP of the wheelchairs was developed from wireframes to high-fidelity screens.

Heuristic Evaluation Results

Round 1 Results

Three "competitor" sites were evaluated according to Nielsen Norman Group's Usability heuristics. Those competitors include: Physioplus, In the know Caregiver Training, and E-Ulift App. The heuristics evaluated were: match between system and the real world, recognition rather than recall, and aesthetic and minimalist design.

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Physioplus: Excellent on all three heuristics

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In the know caregiver training:

• match between system and the real world: Poor

• recognition rather than recall: Average

• aesthetic and minimalist design: Average

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E-Ulift App: Excellent on all three heuristics

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Usability Testing Plan

A plan was created as a format to follow for the usability tests. The plan included background information, objective. research questions, methodology, tasks, participants, recruiting methods, and script for the test.

Usability Testing Results

Round 1 Results

Users: family members, hired caregiver, 2 caregivers/designers who were tested through moderated usability tests. 

Problems found:Alignment, Navigation, accessibility (preferences  - questions need to specify patient condition need, security

In the first iteration, the navigation bottom bar included the whole menu, not the MVP

Round 2 Results

In this wireframe screen, issues included: 

• text box (users preferred check boxes as it was too problematic for this user group.

• full equipment list in menu

In this wireframe screen, issues included: 

• Preference for radial button

• full equipment list in menu

• Alignment

In this wireframe screen, issues included: 

• Need for a back button

• Search box wanted

Round 2 Results

In this mid-fi screen:

• back button was added

• search screen needed to be defined with greyed text

• menu was improved

In this screen:

• text boxes were replaced with check boxes

• Questions were refined for patient's condition and abilities

Summary

In this project, I have conducted research including secondary research, user interviews, affinity and empathy maps, persona creation, user stories and user flows. I have designed the app according to the feedback usability tests and in conjunction with the style guide.  

Participants like the simplicity and ease of the app. Past caregivers stated they wished they had had an app like this when they were caregiving. Current participants want to know when it will be available. 

In round 1, there was no home screen so the home screen was added in this round. Issues also included:

• images for equipment types

• alignment and size of images

Other Research

Because their was a shift from Telehealth Education to Caregiving Equipment, some research was not relevant to the final project. These include a research plan and secondary research, and an empathy map for telehealth with nurses