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Combine design thinking and digital health to provide for the underserved

ICE Graveyard 21/07/2016 Samantha Katz

“Don’t ever forget that you’re weird.”

Not exactly what I expected to hear, years ago, on the first day of my first business school marketing class. This advice is a good reminder that designing for oneself, while straightforward and enticing, will not have widespread impact.

When it comes to healthcare and wellness, the population of people needing support is quite diverse. Not everyone has adequate health insurance, access to specialists, disposable income for a gym membership, education about proper nutrition, a reliable personal support system or convenient internet access to receive messages from providers.

Digital health solutions are well poised to fill this gap. For example, a plethora of telemedicine apps and websites offer patients access to providers who live outside their area or with whom getting an in-person appointment would take weeks. There are innumerable fitness apps and YouTube channels that help people exercise for free at home, and there are equally infinite websites and apps that offer free diet and nutrition education.

Yet, too often these digitalhealth products and services seem designed for those in the same socio-economic situation as the designers themselves. A recent report by the California Health Care Foundation supports this by describing how digitalhealth innovations are not typically created for vulnerable and underserved populations who truly need these technologies. That’s the bad news.

These underserved populations are collectively called the “healthcaresafetynet,” which is defined as those earning less than 300 percent of the federal poverty level and either uninsured or enrolled in a public healthcare program such as Medicaid. Those in the healthtech world probably do not interact with the safetynet population in a meaningful way on a regular basis, so the empathy and future envisioning required to design for them takes some work to develop.

The good news is that designthinking can help!

What is design thinking?

Design thinking is both a mindset and a set of activities designed to create things — products, services, digital experiences, business models — that solve problems. Designthinking is steeped in building empathy for the people you are designing for — a.k.a. users or stakeholders — in order to meet their functional and emotional needs. It includes understanding both their behaviors and — most importantly — why they behave in such ways. In fact, empathy building is the first step in the set of designthinking activities.

Subsequent steps include defining the problem to be solved, ideating potential solutions, prototyping the potential solutions and testing the potential solutions with stakeholders. Rinse and repeat, not necessarily in a linear fashion, improving the design with each iteration.

On the surface it might seem that the safety net population is not a good candidate for digital health interventions.

Building empathy is the most critical element of designthinking, but it also is the hardest. It is difficult to put yourself in the shoes of someone who is very different from you and truly understand their experience, especially if the person is facing some intense challenge such as managing a chronic illness, battling cancer or caring for an elderly family member. Without empathy though, you might not understand the emotional strain put on someone with diabetes every time a well-meaning friend asks what their blood sugar is, and consequently not uphold discreetness as a driving principle in your design.

How to build empathy through design thinking

There are many ways to build empathy when stakeholders’ experiences are foreign to you. The best method is in-context research, which allows you to observe what users do and how their environment — other people, spaces, tools, sounds, etc. — impacts how they complete the task they intend to accomplish. Why is the person attempting the task in the first place? What makes the task easy or difficult? What workarounds has the person invented? How does the person feel physically and emotionally while working on the task?

Sometimes in-context research brings you to some fascinating or far-flung places, and combining observation with in-context interviewing provides a rich data set with which to design. (Note that interviewing alone, especially when done out-of-context, introduces social acceptance bias and misses out on the opportunity to spot elements the user sees as normal but you spot as pain points.)

When in-context research is not possible, lo-fi methods such as video chatting with users, having users record their experiences through video journals, taking part in private Facebook groups and even watching YouTube videos and reading user blogs are the next best options.

Design thinking for the healthcare safety net

On the surface it might seem that the safetynet population is not a good candidate for digitalhealth interventions. We might assume that this group has limited access to smartphones, for example. However, we would be incorrect. Citing that 50 percent of U.S. adults in low-income households (less than $30,000 annually) had a smartphone and 84 percent had a cell phone in 2014, the California Health Care Foundation report makes it clear that the bigger barrier to digitalhealth adoption is not technology access, but rather lack of usability and empathy.

Building empathy is the most critical element of design thinking.

It is critical to meet this group where they are and communicate in ways that resonate with them. For some, language is a barrier, for others the barrier is literacy and still for others it is health literacy, such as understanding health insurance plans, deciphering test results and knowing what questions to ask doctors. Sometimes the primary need is for basic meals, heat or even employment, rather than healthcare.

Text4Wellness and Mobilize4Fitness are mobile services geared toward African-American women who are part of church communities. The service provides texts with health and wellness tips, reminders to exercise, inspirational quotes and information about health and wellness activities with other church members. Using a convenient communication method and familiar language, these services offer an approachable push toward better health that feels familiar to this community.

Additionally, emotional barriers keep some from getting proper care, stemming from a bad experience, fear of significant medical bills or anxiety from not understanding the U.S. healthcare system. One company that is addressing this is ConsejoSano, a provider of telemedicine, chronic care management and health system navigation services by native Spanish-speaking, Latino providers.

Many of the patients that ConsejoSano serves come from Spanish-speaking countries where doctors take the time to get to know not only the patient but also the entire family. When U.S. doctors fail to provide this bedside manner, it can be uncomfortable and confusing for some, keeping them from accessing the U.S. health system in a timely manner. ConsejoSano solves this by offering services with providers who feel familiar to these patients and can more easily empathize with them.

Without designthinking and building empathy for the safetynet, solutions for their care will be suboptimal. Given the shift toward reimbursing for positive health outcomes rather than fee for service, it is even more critical to design tailored solutions that target both functional and emotional needs to help this group live long, healthy and happy lives.

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