HEALTH SHOULD BE CLINICALLY COLLABORATIVE
The Challenge Working in partnership with a large academic healthcare system, how do we create a digital tool that improves the management and prevention of 4 chronic conditions in their patient population: diabetes, pre-diabetes, cardiovascular disease, and obesity? How can this tool motivate patients to become masters of self-care, help patients better navigate health system resources, educate them about their chronic condition, and strengthen the relationships they have with their community?
The Team : Me & 1 Design Strategist
My Role Behavior Change Expertise, Concepting, Creative Direction, Workshop Facilitation, Design Strategy, Illustration
We created Health Ally, a digital tool to help patients better understand their own chronic conditions and patterns of self-care so that they can better communicate with their care coordinators, participate in shard clinical decision-making, and make lifestyle changes to improve their health and well-being.
Health Ally inspires patients to become more engaged in their own health through intrinsic motivation. It provide patients with the tools to understand how adherence impacts how they feel and live. It promotes shared decision-making for a co-created healthcare experience, and involves family members and support systems in a patient’s care.
Integration with Best Clinical Practices
The first step in our process was to conduct a literature review. This allowed us to identify the clinical similarities in the treatment of the target chronic conditions. It also allowed us to understand what interventions had already been tried in all of those areas so that we could learn from those successes and failures.
Through our literature review, we identified 4 common areas of treatment between diabetes, pre-diabetes, CVD, and obesity:
- Physical activity
- Medication Adherence
Insights from Patient and Staff Interviews
We conducted interviews with patients and clinical staff at the health system to better understand the opportunities they identified within the chronic condition journey as well as within the health system itself. We identified key insights that influenced the direction of our project, such as
- Patients were not in a state of mind to retain information directly after a diagnosis. This caused problems for both the patient and the clinician, as the clinician was unable to communicate important self-care information to the patient, and the patient couldn’t remember what instructions the clinician had given them after they’d left the clinic.
- Patients were upset when they made lifestyle changes and their clinician failed to congratulate them at their next appointment. This was demotivating to patients and could put them at risk for behavioral relapse.
- One of the biggest barriers to health in this community was a lack of support within a patient’s family and social networks.
Identifying the Ideal Point of Intervention
We discovered that the biggest opportunity for introducing an intervention to a patient is directly after initial diagnosis of a chronic condition. By introducing Health Ally through a clinician at this time, we can help patients make the best of their heightened sense of urgency and motivation to make lifestyle changes. Introducing Health Ally after initial diagnosis helps patients feel supported by connecting them to the health system resources available to them as a newly diagnosed person and to patient communities that they can look to for support.
Integrating with Health System Processes: Identifying a Clinical Champion
Within the academic healthcare system we partnered with, the Care Coordinator plays an important role. They are able to act as an in-between, helping patients find ways to make clinician recommendations actionable and fit in with their own lives. Clinicians and staff identified that the Care Coordinator would be an ideal person to pioneer the use of a digital tool that would help patients manage their chronic conditions. The Care Coordinator would be able to introduce the tool after diagnosis and could check in on the patient’s progress using the tool at follow up appointments.
Going beyond the clinical treatments
We wanted to do more than simply treat the physical causes of chronic disease. With Health Ally, we had three major aims: educate, facilitate conversations, and promote self-understanding.
Education. Before a person can feel motivated to make lifestyle changes, they must first feel that they understand their condition and thus have the power to affect it. Health Ally incorporates four types of educational resources:
- Daily educational trivia
- Digital library containing disease-specific information & curated by the healthcare system
- Digital resource library containing health system-specific resources available within the healthcare system
- Location-based mobile notifications to inform patients when they are passing a place with disease-specific resources in their immediate area
- Goal suggestions in the four common areas of treatment
- Leveling to help patients increase the difficulty of their goals after they’ve been successful at a present goal
Self-Understanding. Once a person understands what their chronic condition is and how they can affect it for the better, they can start to focus on how their own habits, preferences, and perceptions can affect their condition and motivation to make change. Health Ally provides four self-understanding resources:
- Tracking progress towards a goal
- Prompting patients to identify barriers that prevent a goal from being achieved
- Illustrating connections between behaviors and outcomes
- Performance streak notifications
- Personal reflection prompts based on progress
Communication. After a person understands their condition and how they feel and act with that condition, they can begin to communicate their experience to others to share their journey, foster or strengthen social connections, and ask for support where they need it. Health Ally provides physical and digital tools to facilitate conversations between the following:
- Patients & care coordinators
- Patients & family members
- Patients & community
- Patients & other patients
Health Ally Core Loop: Closing the Gap Between the Clinic and Life Outside the Clinic
Leveling based on the stages of change
After patients achieve multiple successes in the goals they set to improve their chronic condition, Health Ally offers to “level them up”, increasing the difficulty of the goals available to them and helping them become healthier. These levels are based on the stages of change in the Transtheoretical Model developed by James Prochaska and Carlo Di Clemente. Patients in the early stages of change such as pre-contemplation, contemplation, and preparation would work in levels focused on education and learning (ex. Take five of your favorite foods out of the pantry. Locate the “sodium” on the nutrition facts panel. Which of them has the most sodium? Which has the least?”). A higher level based on a action or maintenance might be “eliminate salt from two of your three meals at least 5 days a week”.
Blending the real world and the digital world
One of our core beliefs is that any digital intervention should strive to incorporate aspects of the “real world”. This is proven to make interventions more successful. One of the reasons for this is that it is difficult for anything digital to replace the complexities and richness of face-to-face human interaction, particularly when it comes to doing something as difficult as lifestyle changes. We blend the boundaries between the digital and the “real world” in Health Ally by
- When a patient levels up, the app rewards them with a digital certificate of accomplishment. During their next appointment the Care Coordinator prints out and presents the patient with a physical copy of this same certificate. This allows the Care Coordinator to recognize and celebrate the patient’s progress in the real world as well as the digital.
- The Care Coordinator checking in on a patient’s progress both through in-app messaging, data transparency, and during face-to-face appointments.
- Connecting patients to groups both within the healthcare system and within the larger community. Think “Meet Up” for a specific patient population and geographic area.
- Providing GPS location alerts through a mobile phone when a patient passes a geographic location with resources relevant to their goal or condition. Two examples of these could be a CVS with a blood pressure cuff or a local farmers market.