Mobility Equipment Education for the Caregiver
May- November 2020
UX Researcher | UI Designer
The project began with an idea that started out as being Telehealth education application.
Initially the idea was to create an extension of my dissertation by exploring Telehealth education with nurses. I believed at the time that the problem was that nurses were uneducated on how to use Telehealth for their practices.
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.
I used the design thinking process which allowed for iteration from the initial idea and problem from Telehealth Education for nurses to one that focused more on caregivers. This Image, courtesy of the Interaction Design Foundation, shows the process of iteration very clearly:
My initial assumption was that nurses in the heat of the pandemic were uneducated on Telehealth use in their practices. After interviewing 6 nurses, creating affinity and empathy maps, and personas, I realized that this was not problem that was of greatest need for the nurses.
There were initially 4 personas, 2 different types of caregivers, a nurse, and an elderly patient.
The nurses indicated that they needed a way to disseminate the massive amount of resources on Covid and Telehealth. One nurse said "We need a curated resource for learning about current events regarding Covid and Telehealth".
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.
During the time of interviewing the nurses, caregivers were also interviewed on their needs and relationship to Telehealth. The data showed 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.
Initially it was still a Telehealth issue, until interviews with caregivers revealed that what they needed was understanding mobility equipment.
Realizing that I was wrong on what nurses needed, allowed me to see that caregivers were the forgotten population.
Because of the initial start of using Telehealth as an avenue, I explored how caregivers might be supported through Telehealth. Not all caregivers, or patients have a need for Telehealth. I had assumed that Telehealth could support caregivers. Perhaps it can. However, there is not an urgent need for it. After interviewing more caregivers of different types, they indicated that they needed a different type of support.
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 and the elderly patient, 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.
“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?
How might we provide equipment training for caregivers so that care-workers can lift patients safely without injury to self or patient?
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.
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 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:
Heuristic Evaluation 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.
Physioplus: Excellent on all three heuristics
In the know caregiver training:
match between system and the real world: Poor
recognition rather than recall: Average
aesthetic and minimalist design: Average
E-Ulift App: Excellent on all three heuristics
In the user stories, returning and new caregiving options were given with their goals of learning about new patient mobility equipment.
In the 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 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.
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
text box replaced with check list (due to problematic nature of text box)
menu changed to broad categories
Preference for radial button in scheduling
Requested search box
Round 2 Results
In round 2 users included some previous participants (from the user interviews), instructional designer, real-estate agents, all of which were caregivers.
Participant feedback included: Because they were caregivers with limited time, they appreciated the simplicity of the app
Search box needed to be defined as search box with grayed text
Still some alignment issues
Navigation fixed (bottom bar and home page modified)
Round 1 Results
Back button was added
Search screen needed to be defined with greyed text
Menu was improved with generalized categories
Check boxes replaced text boxes
Questions redefined with patient's condition and abilities
Home screen added
Images for equipment types added
Alignment and size of images adjusted
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.
As this was designed for caregivers, the initial release (providing funding and development) would go out to caregivers (hired and family), as well as nursing facilities. The second planned release would include adjustments to the MVP, and an initial self-care area to care for the caregiver.
Business impact would be less injuries with less doctor and hospital visits per training on equipment.