In my previous post I shared how the current system is built largely around reactive models of care. This downstream approach is shared by many mental health apps leaving many gaps to fill. In this post I want to shift my focus to what user centred design can look like and how it relates to healthcare.
User centred design
Let me lay the groundwork here for what I mean by user centred design. User centred design is an iterative design process in which designers focus on the end user and their needs in each and every phase of the process. To me it means building with the holistic understanding of how people go about their daily life. It’s why Apple moved Safari’s search bar on the iPhone to the bottom so you can tap it with your thumb. No more two handed internet searches!
Research has shown the average delay between symptom onset of a mental illness and the date of treatment to be 11 years. To me this speaks of the larger issues we are facing within healthcare, and is a poor example of user centred design.
While I don’t profess to know everything, after all I’m just some outsider looking in, here are my two cents on how we can get back to focusing healthcare around the people and not just the system.
We dont often think of healthcare from outside the doctors visits or hospital trips. Self-care on the other hand is not thought of as sitting in the waiting room, it’s walks outside or good books to read. But why the stark contrast? Isn’t self-care part of healthcare and vis versa? There’s no stigma around reading books or going for walks. We don’t feel embarrassed walking into chapters or the local library. But when it comes to many mental health approaches stigma is one of the big deterrents.
One component to this is the separation from our daily lives. Most of the help available, and mental health apps for that matter, are so far removed from the users daily life that they are, in part, contributing to the very stigma they look to overcome.
When I was in high school I was, what you would call, a slacker. I didn’t apply myself and subconsciously identified as a one of the dumb kids who didn’t care. With this identity rooted in my own insecurities, I found myself in the “dumb kids math class”. Basically a class for those students who didn’t do well in math.
What’s interesting is the bond I had with these fellow students, it was strong. We were passively united in our less than eager appreciation for all things calculus. But here’s the thing, it made us feel dumber. We were separated from the kids in the smart class. They made fun of us for it and we resented them for that.Now imagine what that may feel like for, let’s say a youth or young adult who’s part of a mental health support group? Or how about one who is seeking professional help?
In high school math just wasn’t my thing. It wasn’t until I went to school to be an Electrician that I realized how much I actually loved math. It was then, in my mid 20’s that I realized that I was actually smart. I had been under this stigma that I was just one of the dumb kids. This was an unintended consequences of grouping students. I don’t profess to know what a better alternative could be to this, but I do think we can do better.
When it comes to things like mental health, wellbeing, and yes even math, separating people into silos only adds to the stigma. This in turn reduces the willingness to seek support and can bring an element of shame to those in need of help.
Move beyond the walls
One critique I have of the Christian church here in North America is the expression of God being reduced to a Sunday morning service. By definition God must be bigger than the 4 walls of the church right? Parents dont just love their kids when they are in their own house. That love goes with the kids, everywhere they go. We can think of the overall approach to peer support of the wraparound model in a similar way. We need to think beyond the silos we have unknowingly created. Methods of care must have the freedom and flexibility to bend beyond formalities. We need to seriously look at how user centred design integrates into the daily life of those we are looking to serve, yes even beyond the group meetings.
A question mental health platform should be asking themselves is: How can we enhance and integrate both natural support structures together with more formal modes of care?
You see, its the natural support structures that have our immediate trust. Its those friends encouraging us to strive for more that inspires us to make change. Not only can our friends and family inspire us, but they are more often than not the very fuel that keeps us going. The weekly coffees, the invites to go for a walk or get out of the house.
In an article from BMC Psychiatry, researchers found that “Informal help was sought twice as frequently (36.1%) as formal help (17.5%). Of those who sought formal help, the majority used informal help as well (69.3%), whereas most people who sought informal help did not use formal help (65.1%).“
We cannot remove natural support structures from healthcare only to seek comfort in silos and control. We gotta think holistically. It needs to get messy because thats where life is happening. To the degree we reduce our silos, or integrate into real life, is the degree we will reduce stigma.
We all know that person, you know who I’m talking about. Whether they be from work, church, or in the line up at the grocery store. They are ones more than willing to share how they just ran their first marathon. With smiles from ear to ear they tell about the training it took and how it was harder then they could have ever imagined. They proudly announce their run times and how it felt to cross the finish line. And so they should be proud! We also know that person who won’t stop showing us pictures of their newborn niece or nephew. OK we get it the baby’s cute!
From babies to marathons, life is fluid. Its movement mixed with emotions and sometimes chaos. One area of our life effects another. The quality of sleep you have can impact your mood the next day. If I dont drink coffee trust me you will know! The strength of your relationships can determine how well we perform at work. Running that marathon can give you that resiliency that may help you through difficulties in your marriage. We don’t live our life fragmented, so why do we build models of care in this manner? After all, don’t you wanna see the baby pictures doc?
The links between
I don’t pretend to have a great grasp on systems thinking, but I can say that healthcare will gain a lot from thinking about an individual’s health in this respect. Marathon times do matter. Healthcare needs to go beyond, well…healthcare.
A few weeks back I had the privilege of chatting with Namrata Bagaria, a PhD candidate from the University of Ottawa and Masters of Public Health graduate from Harvard, while attending the first ever Human Connectedness Conference hosted by the GenWell Project. Namrata told me about her company Seniors Junction, a startup that integrates social prescribing as a means of promoting the health and wellbeing of seniors. Whats interesting about Seniors Junction is that its built around a model which shows how recreational activities can help reduce social Isolation and increase connectedness and purpose.
Pair this together with another Harvard graduate, Robert Waldinger. His well known study found that embracing community helps us live longer and happier lives. An article from The Harvard Gazette quotes Waldinger (as he talks about the people in his study) saying:
“When we gathered together everything we knew about them about at age 50, it wasn’t their middle-age cholesterol levels that predicted how they were going to grow old,” said Waldinger in a popular TED Talk. “It was how satisfied they were in their relationships. The people who were the most satisfied in their relationships at age 50 were the healthiest at age 80.”
Its clear we need to begin to not only thing about healthcare in a more holistic manner but design it as well. To reaffirm this point, in their article in Science, authors Landis, Umberson, House state:
“Social relationships, or the relative lack thereof, constitute a major risk factor for health—rivaling the effect of well established health risk factors such as cigarette smoking, blood pressure, blood lipids, obesity and physical activity.”
Thinking outside the system
What could user centred design look like? You can think of it like this. Let’s say Jamie is Obese and his Doctor explains to him that he’s at risk of diabetes, heart disease and even some cancers. Jamie’s Doctor is amazing and has a great working relationship with a local gym. Because of this relationship, Jamie is rightfully prescribed a gym membership. At the gym, Jamie meets his trainer Nate. Nate looks down at Jamie’s feet, and to his disgust he sees Crocs. Nate tells Jamie to go to the local Running Store to buy proper running shoes.
This is where Jamie meets Dave. Dave knows everything there is to know about running shoes. Being the shoe salesman he is, Dave immediately points and laughs at Jamie’s Crocs (just kidding…but probably). Dave has a conversation with Jamie about his goals, what type of exercise he will be doing and so on. Dave fits Jamie with a great pair of shoes to get him off on the right foot (see what I did there).
After several months of hard work, lots of encouragement and support from Nate and the new friends at the gym, Jamie has now lost a reasonable amount of weight and is feeling much better. Jamie goes back to the Doctor. The Doctor now tells Jamie that he is no longer at risk of the previously mentioned sicknesses or diseases. In fact, Jamies extended his life expectancy.
This lifestyle shift has not only helped Jamie with his physical health, but has created an overflow effect with positive impacts in many other areas in his life.
Here’s the thing. The Doctor, the local gym, the trainer Nate, shoe salesman Dave, and the new friends Jamie has made are all part of this holistic understanding of health. Yes, a shoe salesman can be part of the healthcare system. Friends helping friends is part of the healthcare system. And yes, friends, nonprofits, teachers, coaches, therapists, and doctors should all be working together around an individual’s needs. This is user centred design. Healthcare doesn’t end when we walk out of the doctors office. Healthcare is out here in real life.
We have removed so many players from actively participating by unknowingly reducing healthcare to doctors visits. By focusing on the end user, their needs and their individual life, we begin to see this bigger picture.
This user centred design is core to how we are building our platform. And yes, we want to be the place that will help facilitate the journey, from the doctors office to the shoe salesman. For us, it all comes down to building technology that serves people.
User Centred Design in healthcare
I will go more in depth into what other approaches can look like in a future post. For now I want to focus on the effects that downstream anonymous approaches have, specifically when it comes to technology.
Many, if not all mental health apps, are focused on providing either access to therapists, or anonymous chat forums. Let me just say, this approach serves a purpose and is definitely, without a doubt, needed. Obviously we are huge fans of therapy and community. The problem, no scratch that, the opportunity comes when we look beyond just offering this type of care.
Waiting for people to have serious mental health problems until you see them as beneficiaries of your service isn’t looking from a long term lens. Creating trust and relationship is difficult for any tech platform, especially when you’re profit comes from those suffering with mental health issues. What happens when they get better? Do you lose a customer?
We believe there is more value, opportunity and overall good for the end user when you create something that meets people where they are at. This approach could help to reduce that 11 year journey to finally seeking treatment. Someone may not always need formal care like a therapist, but they sure could benefit from a chat with a close friend. Or perhaps they find support from their local church group or running club.
By focusing on the individual and mobilizing the people in their lives, together with business and healthcare models, such as social prescribing and community referral, we can restructure preventative approaches of care. This will translate into better overall health and have meaningful impacts within societies around the world.
We need to go beyond offering just anonymous communities. We have to create community IRL (for all us older people that means in real life). Its my belief that anonymous communities came to be the standard model for tech because it was the lowest hanging fruit. Simply put, it was the cheapest and easiest way to scale and has found its way into mental health platforms as the go to solution. I challenge the thought that it came from a place of thinking what’s best for the end user.
I may get some backlash from the above statement and that’s ok, who am I to say what’s best for someone anyways? Fare enough, I get that. I also understand the value prop for what an anonymous communities can offer. Here is my challenge though, why keep it at that? Why not help people build and strengthen relationships with those in their daily life as well? Why not also connect them with people in their own community? One hunch I have is that it can get messy. There is less control when things are moved into real life, but with that shift comes greater utility.
Where we see opportunity
This is why we are so excited to build out our platforms search capabilities. By empowering individuals to crowdsource wraps we will create a marketplace of enablement. Not only will we be able to connect users with professionals, but friends helping friends is the inspiration that keeps us moving forward toward achieving meaningful goals in our lives.
Additionally, our aim is to foster both bonding and bridging social capital by leveraging geographical search capabilities. Think about how we can help empower the local peer support community, AA, church groups, or running clubs.
Anonymity has its benefits but it also has disadvantages. It’s a piece for sure, but it certainly isn’t the piece. Any company looking to create sustainable change has to integrate both the digital world together with the physical community its users find themselves in. We can no longer reduce people to anonymous profiles and user names. Think about how we can begin to integrate them into the users daily life.
To wrap it up
User centred design can help restructure healthcare by focusing on the individuals and mobilizing people, together with business and social models. Our fit is not to replace rather build the bridges between the formal and informal. We want to empower both the doctor and the shoe salesman because that is whats best for the end user.
In the next blog post I’ll spend more time focusing on approach and explore the opportunities of prevention and how this results in value creation.
Photo Credit: MART PRODUCTION from Pexels