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ERAC APP
for UW Medicine
A Mobile App for Enhanced Recovery After Cesarean Surgery
OVERVIEW
The app aims to empower mothers with information during their cesarean surgery journey, and has resulted in increased mothers' motivation to recover proactively. Led by Dr.Laurent Bollag, MD, this practicum project was sponsored by the Labor & Delivery Department at University of Washington Medical Center. Our team from the Information School worked in collaboration with UW Medicine, conducting a field study and user research to design the ERAC mobile app.
DURATION
Jun 2022 - Aug 2022
8 weeks
TEAM
UX Designer x2
UX Researcher x1
Project Manager x1
MY ROLE
UX Designer + Researcher
METHODS
Field Study
Literature Review
User Interview
Information Architecture
A/B Testing
Usability Testing
01/ OPPORTUNITY
Why we are working on ERAC app?
Dr.Bollag at UW Medicine helped develop the US National guidelines for Enhanced Recovery after Cesarean deliveries (ERAC). Mothers on enhanced recovery pathways reduce direct hospital costs by $1500 per delivery, experience less post-partum pain and as a consequence use less opioid pain medication (an important issue during the current opioid crisis in the US). Importantly, mothers on ERAC pathways experience better maternal-fetal bonding, breastfeeding success and wellbeing. Dr.Bollag has implemented these guidelines at the UW Medical Center and would like to scale them out to more hospitals over time. Based on his recent work, including these national guidelines and his clinical experience on Labor and Delivery, Dr.Bollag has an interesting idea to empower mothers to be part of their recovery team and to increase patient pathway compliance using a phone-based checklist that could potentially connect with EHR systems.
This project is aim to create recommendations/user-guidelines to prevent confrontational situations between patients and hospital staff are avoided, since patients using the app will be aware of their evidence-based treatment plan. The Covid-19 pandemic increased stress levels in hospitals and health care facilities across the United States (and world-wide) due to staffing issues. This application has the potential to close this gap by informing patients and allowing care teams to focus better on clinical activities.
What are the challenges?
Our team was required to complete the entire process from research to design in eight weeks. With such a tight timeline, we had to break down the tasks and manage multitask simultaneously. As a medical-related project, we committed to complying with research ethics and fully respecting patient privacy, as well as being sensitive to any patient concerns.
Therefore, we developed a project plan to ensure that the entire research-design process can be completed with high quality and within the specified time frame:
This plan entails conducting research and design tasks in parallel. As a designer, this requires me to begin the design process even when the research findings are incomplete, and also be flexible and agile in making adjustments to the design based on the research output during the design process.
02/ RESEARCH PHASE I - WHAT USERS NEED?
FIELD STUDY
Not only help patients recover better physically, but also give them mental support to reduce anxiety about the surgery and recovery.
After visiting UW Medical Center guided by medical professionals at the labor and delivery department,
we gained a comprehensive understanding of the cesarean surgery procedure, which extends beyond the hospital environment. We recognized that mothers can benefit from advance knowledge of the recovery process in the absence of medical support, both pre- and post-hospitalization. In busy hospital settings, receiving timely care assistance can also be challenging for patients.
We see a valuable opportunity to bridge the information gap between patients and healthcare providers. Through our project, patients can access care guidelines via a mobile app, regardless of whether they are. This app can not only help patients recover better physically, but also give them mental support to reduce anxiety about the surgery and recovery.
RECRUITING USERS
Interview scripts were first reviewed by medical professionals to ensure gentleness and accuracy of wording.
We wanted to understand what users at different stages of delivery thought about the recovery process. We recruited users under the guidance of a physician, which took longer than we expected to take to recruit due to the special situation of the users.
We ended up recruiting 6 interviewees (including patients, nurses, and doctors).
Our interview scripts were first reviewed by medical professionals to ensure gentleness and accuracy of wording.
Flyer for recruiting
LITERATURE REVIEW
Care mobile apps are proven to be effective for post-surgery care and patients are more confident in their recovery outcomes when they use these apps.
By reviewing relevant literature, the ERAC guideline, and the comparison and analysis of similar products, we found that care mobile apps are proven to be effective for post-surgery care and patients are more confident in their recovery outcomes when they use these apps. Similar products allow patients to learn about care information by completing self-evaluation checklists or questionnaires.
USER PERSONA
Design for mothers who have plans to have cesarean surgery and also mothers who unexpectedly have cesarean surgery during childbirth.
We started initiating persona at this phase and gradually refined this persona as more and more findings were found in following research. We designed this App for:
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Mothers who have plans to have cesarean surgery;
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Mothers who unexpectedly have cesarean surgery during childbirth.
03/ RESEARCH PHASE II - HOW IT CAN BE SOLVED?
INTERVIEWS
We wanted to learn from interviewees about:
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Where the patients collected their information from and how confident they felt about those sources;
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Their feeling and emotions throughout the journey;
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What were their main concerns about recovery post the delivery.
After interviewing with 3x users and 3x stakeholders, we distilled three main needs from the interview scripts. We found common feedback and talking points between the stakeholders and users, and these common needs became the basis of features prioritized in the application design.
USER JOURNEY
Based on previous field study and interviews, we mapped up the user journey to better find out the pain points and opportunities during the post-surgery recovery process.
04/ DESIGN PHASE I - WHAT IT MIGHT BE?
INFORMATION ARCHITECTURE
Our design process began with information architecture, where we created a site map as the first step. Simple but useful. This helped us sort out information and convert our thoughts and ideas into logical structures. I then aligned and confirmed the design direction with the sponsor at this stage, which has greatly reduced potential time and communication costs for future adjustments.
CHALLENGES
Confirm the two main features for the App: An interactive recovery journey and a portable recovery booklet.
These two features together can let users to track their recovery process and access to needed information regardless of time and space.
01/
What type of interaction enables users to both access care information and track their own recovery progress?
As mentioned above, there are two main methods for users to access information and track progress in the industry: checklists and questionnaires. We chose to design an interactive checklist after analyzing the pros and cons of both types of interactions and seeking feedback from medical professionals.
Some pictures of the brainstorming process
Another designer in the team and I had different ideas about the checklist design. We agreed that users should have the option to choose their preferred interaction method so we collaborated to produce two checklist versions, and did the A/B testings for both versions afterwards:
Version A: Users can mark completion under each item while viewing the daily recovery guideline
Version B: The checklist has a separate entry on the daily recovery guideline interface, users can click on the checklist to mark on it while viewing the guideline
02/
How to encourage users to mark their progress but not making them feel anxious and stressed about it?
If the checklist only serves as a simple record of completion, it may lack motivation for users. Conversely, if the checklist is purely a reminder, it can make sensitive users feel anxious about their progress. To strike a balance, we chose to visualize the completion of the checklist so that users can track the changes in their recovery journey and perceive that their recovery is happening gradually. Additionally, we added optional reminder function to assist users with task management as needed.
When marked a task completion from the checklist, a rewarding star will pop up to the interface.
The reward star will be collected to the relevant category. There are progress bars and task numbers under each category indicating how many tasks have been completed.
Since every user's medical condition and recovery process may vary, not all suggested tasks on the App are applicable to all users. We avoided using language and symbols that imply "correct/incorrect," such as "red/green" and "check/cross," opting instead for more neutral language and colors when doing the checklist design. We understand that users may experience negative emotions during the recovery process, therefore, completing a task will receive positive feedback from the App, while not completing a task does not result in any negative feedback from the App.
03/
How can we empower users to proactively engage in their recovery journey?
We prioritized empowering mothers to proactively engage in their recovery journey, rather than treating them as passive recipients of information, as expected by both users and medical professionals. We broke down daily recovery tasks based on ERAC guideline. In the Journey interface, users can view the task plan for the day by selecting the date, so they can be informed and prepare the procedure in advance. We also designed a daily check-in questionnaire that not only documents the recovery status but also encourages users to seek appropriate advice through self-evaluation.
Answering a series of simple questions about physical conditions and get the advice
STYLE GUIDE
We used navy blue and coral red as the primary colors, warm colors help to create a relaxed atmosphere for users. We opted for Open Sans for fonts due to its wider spacing and sans-serif style which enhances readability and the rounded font design reduces the formality of medical-related terminology.
05/ DESIGN PHASE II - HOW IT CAN BE BETTER?
A/B TESTING
We then conducted A/B Testings with 3 mothers who just gave birth recently. We let users experience the initial prototype freely and both versions were given for them to try using the checklist to mark the recovery journey.
Version A received feedback as intuitive and easy to follow, while Version B received feedback as easy to see the progress at a glance but the entrance of the checklist is not obvious as Version A. Although it took users longer to find the checklist on Version B, they expressed a preference for its progress visualization feature.
Intuitive: A > B
Progress visualization: B > A
Version A
Version B
We cannot simply conclude from the feedback that one version is better than the other, but we can take the advantages of each version and integrate the design. In addition to getting feedback on both A/B versions, we also got more valuable findings from the A/B Testings to carry out in future prototype design. Three more functions that users want to use in the app are:
ITERATION
Iterated the design after we completed evaluation for the initial prototype by doing usability testings with 3 users.
Progress Visualization updated by following reasons:
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We got feedback from users that the "star" element tends to be perceived as more of a "collection" than a "reward"
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The number of items in the progress bar with stars is not intuitive
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When a user completes a task and gets a "star reward", the current system does not actually accumulate the number of stars received, and the user is not motivated by the number of stars counted.
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Users can't see how many questions in the check-in questionnaire, and the check-in progress is not clear. This may discourage users to fill out the questionnaire if they are unsure about what they are being asked to do or how long it will take.
We have made the following adjustments for the progress visualization:
Replaced star with a warm pic, use "You just completed a set of goals" instead of "You have earned 1 star".
Updated the progress bar for more intuitive. Easily see all progress at a glance.
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Categorized questions into different sections, and displayed the progress of check-in at the first page. Added progress bar on the top when answering questions and feature for users to save and back at any time. Users can now not only clearly see the progress of each section, but also proactively decide the section and order they want to self-evaluate according to their own situation.
FINAL SOLUTION
The final design solution featuring the digitalized care guideline, the interactive recovery journey, the check-in questionnaire, the goal-oriented reminder.
Portable and searchable care guideline with multimedia
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Digitalized from the UW Medicine's postpartum care booklet, the care guideline not only provides information about cesarean surgery care but also comprehensive postpartum knowledge.
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Highlights signs that users should be aware of
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Users can access various types of information such as articles, videos and audio.
Check-in questionnaire for self-evaluation
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Starts with warm greeting questions to make users feel being cared for and cared about.
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Categorizes common questions into different sections.
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Allows users to quit and save the questionnaire anytime, and to see the progress of each section.
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Provides applicable advice after answering questions.
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Prompts "Contact care provider" when more help needed.
Goals-oriented reminder
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Divides goals into "My goals" and "Goals advised by doctors" for different goal management.
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Allows users set up their own goals and reminders.
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Progress bars indicate the recovery progress for each section.
Interactive recovery journey with
day-to-day break down goals
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Allows users to browse recovery goals on a daily basis.
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Allows users to set relevant reminder for each task if needed.
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A pop-up appears when a set of goals is completed for encouragement.
06/ REFLECTION
What did I learn?
It is crucial to ensure that ideas and project progress are synchronized with other teams in a timely manner, particularly when working on projects with short deadlines. By synchronizing information with other teams and reaching a consensus on key decisions before moving on to the next step, time and communication costs can be greatly reduced.
When collaborating with cross-disciplinary teams, it's essential to use simple and easy-to-understand design language and take the initiative to introduce and explain the design process to each other. This can help avoid confusion and misunderstanding of the output that can arise between teams with different backgrounds.
Research and design can be conducted simultaneously by planning the project according to time and tasks. Although we started with a traditional design process, real-world constraints required us to make timely adjustments to the plan.
A flexible project process and a responsive estimation of time and task volume were the key in completing this project successfully.
Even if the other team is not a design team, people in other fields can still give great design ideas and suggestions! Good communication helps us sprout more inspiration.
What can be better?
Identify the project scope and design direction earlier. As a new project, each team member had different ideas and expectations, leading to too many goals are wanted to be achieved. It was challenging to choose among these ideas, resulting in a delayed design process and scattered ideas on the design draft that were difficult to integrate. If we had evaluated the tasks and established the project's scope boundaries earlier, we would have had more time to evaluate and iterate on the design.
Time constraints and user specificity prevented us from completing more user interviews, and we did not have a deep enough understanding of the user community. This resulted in a single user profile that did not cover more different types of users.
07/ FUTURE
IMPACT
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Empowers patients to proactively learn about and take control of their recovery journey, thus increasing their confidence in recovery.
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Better uses technology to apply ERAC guideline, which not only helps patients recover better from cesarean surgery, but also helps promote ERAC guideline to a wider audience.
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Helps to free up the workload and reduce the stress of healthcare professionals through coverage of common questions.
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Fills the information gap and enables patients to access care knowledge and assistance when they are unaccompanied by healthcare professionals.
NEXT STEPS
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The language used in the app's design is being reviewed by medical professionals, UW Medicine has additionally invited psychologists to embellish the language used in the app to better communicate with patients.
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The project is currently in its second round of research and design at the Information School.
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In the future, the ERAC App is expected to have access to E-HR, enabling timely information synchronization between healthcare professionals and patients.