The Prescription Mobile App For Chronic Disease Management

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THE PRESCRIPTION MOBILE APP: Productizing behavioral care for people managing a chronic disease and needing behavioral therapeutic support

THE PRESCRIPTION MOBILE APP: Productizing behavioral care for people managing a chronic disease and needing behavioral therapeutic support

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  • 1. PRESCRIPTIVE APPS: Delivering therapeutic behavioralcare to chronic disease patients, enabling personalizedself-management ofdiet, fitness and stress.Michael Eckersley, PhDDesigning  a  wellness  economy            THE PRESCRIPTION MOBILE APP: Productizingbehavioral care for people managing a chronicdisease and needing behavioral therapeuticsupport1This work is licensed under a Creative Commons Attribution 3.0 Unported License.
  • 2. AcknowledgementsThe  following  summarizes  research  and  design  planning  undertaken  by  Interaction  Design  and  Design  Management  students  at  The  University  of  Kansas,  over  Fall  2012  and  Spring  of  2013.  The  project  was  developed  and  directed  by  Michael  Eckersley.  The  initial  work  was  presented  December  4,  2012  at  the  KU  Center  for  Design  Research,  Lawrence,  KS.  Subsequent  development,  editing  and  integration  was  undertaken  independently  by  Michael  Eckersley  thru  HumanCentered,  an  independent  research  and  design-­‐planning  consultancy,  and  published  online  June  12,  2013.Contributing  Authors:  Design  Management  Team:  Peter  Henne,  Nicolette  Niosi,  Justin  Powell,  Todd  Register,  Adam  RoushInteraction  Design  Team:  Amanda  Boyd,  Ren-­‐Wei  Harn,  Tyler  Lagally,  Noah  Albro,  Casey  Franklin,  Karen  Moore,  Nicolette  Niosi,  Caitlin  OConnor,  Trey  Toman,  Lauren  Bock,  Kaitlynn  Howell,  Sera  Lanzer,  Nicole  Luby,  Megan  Miller,  Nick  Troll,  Whitney  WhallonScenarios  &  Simulations  Team:  Petter  Henne,  Nicoletta  Niosi,  Todd  Register,  Adam  Roush  Program  Sponsor:Thanks  to  Bayer  Healthcare  for  their  support  of  the  KU  Center  for  Design  Research.Contact:  mde@ku.edu  or  michael@humancentered.net0. Acknowledgements 21. Introduction & Background 32. Research Question, Chronic Disease Literature 53. The Project Twofold Objective 9UX Scenario 1: “‘Ben’s’ Story” 104. On Human-Centered Design Innovation 115. Researching and Modeling the User/Patient 13UX Scenario 2: “‘Eleanor’s’ Lifestyle Change” 166. Market Analysis:Consumer Behavioral Health TrendsPersonal Health Devices Consumer MarketMapMarket Analysis: Current Device UX vs.Benchmark UX In Personal Health Devices178. Business Modeling:Stakeholder MapsProposed Managed Care System MapSolution Strategy20UX Scenario 3: “‘Joe’s’ Osteoarthritis” 239. The Consumer App Suite: Early Development :Top-Level Device UI Wireframe, Navigation2410. The Nutrition App: Features, Concept Wireframe,UX Use-Case2511. The Stress Management App: Features 2712. The Fitness App: Features, UX Use-CaseUX Scenario 4: “Adam’s Resolve” 3213. Bibliography 332Contents & Acknowledgements
  • 3. 1. Introduction BackgroundThis  research  builds  on  earlier  research  and  design  planning    from  2009  involving  "Service  Tools  For  Innovating  Chronic  Disease  Management".  The  present  study  explores  a  model  and  a  technology  platform  for  delivering  effective  personalized  behavioral  therapeutic  care  to  people  suffering  from,  or  at  risk  for,  chronic  disease,  with  the  purpose  of  helping  them  better  self-­‐manage  their  diet,  ^itness,  and  stress.  Treatment  and  prevention  of  chronic  disease  is  a  largely  under-­‐utilized  component  of  Public  Health  policy  and  of  the  U.S.  Affordable  Care  Act.  By  modifying  the  behaviors,  lifestyles  and  cultural  norms  contributing  to  excessive  rates  of  chronic  disease,  overall  healthcare  demand  can  be  reduced  signi^icantly,  thereby  making  health  care  more  ef^icient,  more  affordable  and  ultimately  more  humane.The  governing  agent  in  reducing  chronic  disease  generally  is  consumer  behavior.  Therefore,  effective  treatment  programs  and  incentives  should  be  developed  by  managed  care  providers  to  help  consumers  better  govern  their  behaviors,  thus  preserving  their  health  and  better  ensuring  their  own  economic  security  and  quality  of  life.  Modest  reductions  in  preventable  risk  factors  could  result  in  40  million  fewer  cases  of  chronic  disease,  and  an  aggregate  savings  of  more  than  $1  trillion  by  2023.    Stemming  the  demand  for  avoidable  health  care  services  is  the  silver  bullet  in  any  serious,  sustainable  health  care  solution.–  Michael  Eckersley,  “Solving  The  Economics  of  Health  Care:  How  Employer-­Provider  Partnerships  Are  Producing  Cost  Savings  and  Healthier  People”CMS3source:  Centers  for  Disease  Control.  CDCs  Healthy  Communities  Program.  Brochure.  Atlanta:  Author,  2011.  Cdc.gov.  2011.  <www.cdc.gov/healthycommunitiesprogram/communities/pdf/hcp_brochure.pdf>.
  • 4. About  Chronic  DiseaseChronic  diseases  comprise  a  group  of  noninfectious,  long  term,  often  preventable,  and  their  worst  effects  are  often  avoidable.  For  our  purposes,  they  include  Cardiovascular  Disease,  Diabetes,  COPD,  Cancer,  Asthma,  and  Liver  Cirrhosis.  Though  others,  such  as  Crohns  Disease,  Epilepsy,  Hypertension,  Arthritis,  Chronic  Pain,  and  Parkinsons  Disease  are  often  included  in  the  list  of  chronic  diseases.  Determinants  include  poor  diet,  inactivity,  obesity,  smoking,  psychosocial  stresses,  genetic  predisposition.  Causes  or  compounding  factors  include  lifestyle  choices  and  behaviors,  lack  of  regular  health  checkups  and  preventive  care.  Chronic  diseases  cause  over  80%  of  deaths  in  the  US,  according  to  the  National  Center  for  Health  Statistics,  2006.An  aggregate  focus  on  chronic  disease  makes  sense  from  a  public  health,  medical  management  perspective  given  how  many  of  the  same  behaviors  or  lifestyle  features  are  contributing  factors.  Though  each  disease  has  its  own  distinguishing  pathology  and  set  of  expressions,  many  chronic  diseases  share  many  of  the  same  basic  treatment  elements.Source: Newsweek Web ExclusiveSource: The Miliken InstituteSource: National Center for Health Statistics, 20064Background
  • 5. Change  Motivation  and  Cognitive  Behavioral  Therapy  Because  behavior  and  lifestyle  factors  are  common  contributors  to  chronic  diseases,  appropriate  modi^ication  of  those  behaviors  can  aid  in  treatment.  Cognitive  behavioral  therapy  is  a  psychotherapeutic  approach  useful  in  treating  dysfunctional  emotions,  maladaptive  behaviors,  and  cognitive  processes  by  means  of  a  number  of  goal-­‐oriented,  explicit  and  systematic  procedures.  Based  on  a  set  of  basic  principles  and  techniques,  cognitive  behavioral  therapy  can  be  an  effective  tool  in  helping  anyone  reduce  body  weight,  improve  diet,  and  better  manage  stress.  The  is  a  transformational  process  for  the  individual  and  it  typically  involves  the  following  goals:  1.  Compliance  to  treatment  plan2.  Symptom  Reduction3.  Healthy  self  perceptions  (i.e.,  lifestyle,  activity  level,  life  meaning,  spirituality),  and  perceptions  of  the  illness4.  Acceptance  of  loss  of  pre-­‐illness  sense  of  self,  lifestyle-­‐-­‐both  in  the  patient  and  his/her  partner*52. Research Question  Q:  What  kinds  of  tools  or  aids  could  afford  chronic  disease  patients  the  ability  modify  the  behaviors  or  lifestyle  habits  (e.g.,  poor  diet,  overeating,  inactivity,  stress,  poor  habits)  that  contribute  to  their  disease  and  hinder  recovery?A  transformational  journey*Treatment  of  Chronic  Medical  Conditions,  Len  Sperry,  American  Psychological  Assn.,  2008
  • 6. Awareness:Knowing  what  their  dietary  habits  are,  and  how  those  are  affecting  their  health.Becoming  aware  about  their  ability  to  control  their  health  through  choice.Knowing  they  arent  alone.Relevance:Understanding  the  affects  food  choices  make  on  their  health,  and  being  able  to  visualize  that.Doctors  or  dieticians  being  able  to  interact  with  patient  choices.ConEidence:Gaining  motivation  through  feedback,  friends,  and  facts.Being  in  control  of  their  own  health  and  weight.Knowing  that  they  has  the  tools  to  make  healthy  choices.Knowing  that  they  are  able  to  track  their  information  easily  in  a  way  which  ^its  their  life.Satisfaction:Seeing  results  both  in  numbers,  and  photos.Being  able  to  connect  with  others  and  share  their  success.Source:  A  Persuasive  Model  for  Behavioral  Design  (Fogg,  2009)An  ethnographic  photography  of  food  intake  allowed   patients   and   clinicians   the  opportunity   to   re^lect   on   patient’s   dietary  issues,   understand   the   context   of   these  problems,  and  gain  awareness  of  habits  that  contributed  to  unhealthy  diet  (Keller,  Fleury,  &  Rivera,  2007).Another   study   found   that   dietary   self-­‐monitoring(i.e.   self-­‐weighing   and   keeping   a  food   journal)   was   associated   with   more  successful   weight   loss   over   a   12-­‐month  period  (Kong,  et.  al.,  2012).6Behavior  ModiEication  and  Diet What  People  Need  To  Break  Unhealthy  Diet  Patterns
  • 7. 7Behavioral  Issues  • Inadequate  breathing  patterns• Insuf^icient  ^luid  intake• Poor  appetite,  eating  habits,  &  nutrition• Sleep  disturbances• Substance  abuse• Inadequate  or  inappropriate  exercisePsychological  Issues• Fatalism• Chronic  Impatience• Sustained  stress• Protracted  grieving• Depression• Absence  of  purpose  &  goals• Lack  of  self-­‐assertiveness• Lack  of  trusted  support• Poor  coping  ability  in  times  of  crisisMedical  Issues• Repeated  exposure  to  sickness• Limited  capacity  for  self-­‐care  when  sick• Limited  involvement  in  health-­‐related  issues• Passive,  uninformed  relationship  with  primary  care  providersSource: Jeffrey M. Leiphart, Ph.D. University of California,San Francisco, HIVInSite: www.hivinsite.ucsf.edu• Type  "A"  personalities  are  encouraged  to  develop  and  maintain  regular  routines  of  "deep  relaxation"• Patients  with  chronic  high-­‐level  stress  are  encouraged  to  develop  a  concrete  plan  to  ameliorate  the  identiEiable  sources  of  stress  in  their  lives• Patients  need  to  learn  to  be  aggressive  about  deElecting  stress• Patients  with  inadequate  breathing  patterns  are  instructed  to  practice  simple  deep-­breathing  exercises• Moderate  exercise-­‐a  walk  of  20  minutes  duration  three  times  a  week,  for  example-­‐will  reduce  psychological  stress  and  improve  immune  function    (Fitness  Section)• Patients  should  be  able  to    discuss  their  health  status  on  a  regular  basis  Stress  and  Chronic  DiseaseElements  of  Stress  Reduction  CounselingHow  Stress  Affects  the  Heart• Heart  rate  increases• The  rate  of  blood  ^low  speeds  up,  increasing  blood  pressure• Fatty  acids  are  released  into  the  bloodstream  for  energy,  increasing  cholesterol  and  triglyceride  levels• Cortisol  is  continuously  released  into  the  bloodstream  during  times  of  chronic  stress,  affecting  the  where  the  body  stores  fat  -­‐  most  commonly  in  the  abdomen.
  • 8. 8Fitness  and  Chronic  Disease BeneEits  of  Quick  Exercise  Routines  in  the  Workplace• Simple  cardio  routines  do  not  require  any  equipment  at  all.• Exercise  can  boost  endorphin  levels,  relieving  stress  and  providing  a  boost  to  their  self-­‐con^idence,  which  can  bene^it  job  performance.• Desk  jobs  also  increase  the  strain  on  your  back,  wrists,  eyes  and  neck.• Research  shows  that  a  quick  ^ive-­‐minute  workout  can  have  a  positive  effect  on  stress,  body  weight  and  energy  levels.  Fitness  is  more  than  losing  weight.  • Cardiovascular  Fitness  reduces  chances  of  heart  attack• Muscular  Strength  ensures  mobility  and  independence• Balance  reduces  fall-­‐related  injuries• Flexibility  yields  freedom  of  movement  in  simple  tasks• Body  Composition  increases  more  energy  and  improved  moodSource: http://www.nia.nih.gov/health/publication/exercise-physical-activity-your-everyday-guide-national-institute-aging/chapter-5“Martys  ‘Exercise  Buddies’  Keep  Him  Going”"Every  morning  I  head  out  to  the  mall  —  not  to  shop,  but  to  join  my  mall-­‐walkers  group.  At  75,  I’m  one  of  the  youngest  members.  When  I  retired,  my  wife  Harriet  insisted  that  we  walk  every  morning.  Some  of  us  move  at  a  steady  clip  through  the  mall,  while  others  take  a  slower  pace.  We  count  our  laps  and  keep  a  daily  record  of  our  progress  —  pushing  ourselves  to  go  a  little  faster,  a  little  farther.When  Harriet  died  unexpectedly,  it  was  quite  a  blow,  but  the  walkers  were  my  lifeline.  They  kept  me  moving  when  all  I  wanted  to  do  was  sit.  At  ^irst,  I  walked  because  it  was  something  to  do  each  morning.  But  now,  I  realize  that  I  like  how  it  feels  to  be  moving.  Measuring  how  fast  I  can  walk  gives  me  goals,  something  to  work  toward.  I  walk  and  feel  stronger  every  day.  I  often  think  of  Harriet  and  silently  thank  her  for  insisting  that  we  walk  together."Source:  http://www.nia.nih.gov/health/publication/exercise-­‐physical-­‐activity-­‐your-­‐everyday-­‐guide-­‐national-­‐institute-­‐aging/chapter-­‐5  (2011)Making  Fitness  More  Social  
  • 9. 3. The Project Twofold ObjectiveObjective  1.  Integrated  Personalized  App  Suite.  Create  a  product/service  application  available  by  physician’s  prescription  to  chronic  disease  patients,  enabling  them  to  set  goals  and  track  progress  in  relation  to  physical  activity,  diet,  and  stress,  thereby  improving  general  health  and  ^itness.Objective  2.  Business  Model  and  Channel  Strategy.  Introduce  a  new,  high  value  product/service  offering  into  the  personalized  health  care  marketplace  as  part  of  a  provider-­‐de^ined  medical  management  plan  and  treatment  formulary  that  incorporates  real-­‐time  back-­‐end  connectivity  to  the  patient’s  medical  record.9
  • 10. 10User Experience Scenario 1: “‘Ben’s Story”A user experience scenario*“downloaded from the future” tellsthe story of “Ben”, a 28 year-oldathlete who confronted a personalhealth crisis in the form of Type 2diabetes diagnosis.https://vimeo.com/61838968“Ben’s Story”*  Product/service  user  experience  scenarios  help  teams  see  the  context  in  which  a  new  idea  or  offering  could  play  out  in  the  marketplace  and  in  the  lives  of  customers.  These  advance  snapshots  enable  decision-­makers  to  assess  the  merits  of  a  value  proposition,  assess  its  implications  and  make  better  a  priori  business  decisions.
  • 11. Design  is  all  about  looking  carefully  at  qualities  of  human  experience,  understanding  the  context  of  practical  considerations  involved,  then  designing  things–products,  services,  experiences–that  create  new  value  for  people,  change  markets,  transform  industries.  In  the  words  of  Tom  Peters,  "Design  is  only  secondarily  about  pretty  lumpy  objects,  and  primarily  about  a  whole  approach  to  doing  business,  serving  customers,  and  providing  value."  Thereby,  “(d)esign  has  become  central  to  enterprise  strategy."      114. On Human-Centered Design Innovation“The  human-­centered  approach  puts  people’s  needs  Eirst,  technology  second.  It  focuses  upon  human  activities.  It  makes  the  technology  invisible,  embedded  within  activity-­speciEic  information  appliances.  Simple,  powerful,  enjoyable.”  –Donald  Norman
  • 12. 12On Human-Centered Design Innovation Every  business  has  a  front  stage  and  a  back  stage.  The  front  stage  comprises  everything  about  the  brand  offerings  that  is  discernible  to  customers  and  to  the  public.  The  back  stage  is  made  up  of  all  the  people,  processes  and  operations  behind  the  scenes  that  deliver  everything  that  happens  front  stage-­‐-­‐good,  bad  and  in-­‐between.Great  product/service  experiences  must  be  understood,  developed  and  delivered  as  an  integrated  system  solution,  not  as  discrete,  individual  parts.  This  involves  a  process  of  discovery,  synthesis,  construction,  and  re^inement:  1.  Discovery.  Identifying  the  environment,  customers,  and  stakeholders.  Understanding  essential  organizational  intent  and  core  competencies.  Discerning  brand  perceptions  market  conditions.  Clarifying  points  of  intersection  or  interface  between  company  and  its  various  constituencies:  e.g.,  markets,  customers,  stockholders,  competition.2.  Synthesis.  Making  deep  connections  with  both  customers  and  internal  stakeholders.  That  means  clarifying  various  customer  types:  i.e.,  their  characteristics,  expectations,  goals,  tasks,  options.  That  means  mapping  pathways  processes,  customer  journeys,  points  of  friction.  It  also  means  getting  a  clear  ^ix  on  the  organizational  culture.  Who’s  involved  and  engaged?  Who’s  not?  What  are  prospects  for  change?  3.  Construction.  Great  product/services  experience  means  understanding  customers  deeply:  Building  user  personas  and  archetypes,  stories;  understanding  crucial  service  moments;  clarifying  value  aspects;  prototyping  ideas;  creating  practical  value  scenarios;  planning  and  rehearsing  customer  interactions.4.  ReEinement.  Every  piece  in  this  performance  has  to  be  piloted,  assessed,  tweaked,  communicated,  documented,  and  revised  as  necessary.Start here
  • 13. 135. Researching and Modeling the User/Patient Ethnographic User Research of Chronic Disease PatientsIndividuals  with  one  or  more  chronic  disease  were  interviewed  by  students  to  explore  the  user  experience  of  the  disease,  symptom  management,  and  assess  general  and  speci^ic  requirements.  Information  and  insights  from  these  interviews  were  helpful  in  constructing  basic  user  persona  models  of  two  typical  chronic  disease  patients  who  we  named  “Sam”  (diagnosed  with  heart  disease)  and  “Jill”  (diagnosed  type  2  diabetes).  From  these  descriptive  models  we  were  able  to  embellish  with  plausible  personality  features,  needs,  and  user  requirements.  Cognitive  behavioral  psychotherapy  (CBT)  is  a  biopsychosocial  approach  to  healing  which  focuses  on  how  we  think  and  evaluate  ourselves,  others  and  the  situations  we  =ind  ourselves  in.  Treatment  involves  evaluating  the  patient’s  “explanatory  model”  or  personal  explanation  for  the  causes  of  their  problems,  their  symptoms,  and  impairments.**Treatment  of  Chronic  Medical  Conditions,  Len  Sperry,  American  Psychological  Assn.,  2008SituationThoughtsBehaviorsMoods/FeelingsPhysicalReactions“Jill”diagnosedType2 diabetes“Sam”diagnosedheart disease
  • 14. Patient  proEile:• 56  yo  white  male• Spouse:Margie,  a  48  yo  female• Children:  “Beth”  19yo  female  (college);  “Riley”    23yo  male• Formerly  prep  athlete.  Sedentary.  Limited  social  af^iliations.  No  close  friends.  Chiefs  fan.  Used  to  restore  classic  cars.• Accountant.  Owns  own  ^irm.  Works  long  hours,  especially  during  tax  season.• Financially  stressed,  lost  much  of  retirement  nest  egg.  Retirement  is  a  distant,  fading  dreamDisease  context:• Heart  attack  2004  (stent),  possible  mild  stroke,  high  blood  pressure,  obese,  stress  • “I’m  a  fat  guy,  have  been  overweight  since  high  school”• Resistant  to  lifestyle  changes;  no  idea  how  or  where  to  start• Struggles  with  balanced  diet.  Fast  food  meals  several  times  a  week.14**Keller (1983) ARCS Model“Sam”diagnosedheart diseaseawareness relevance confidence satisfaction“Sam’s” transformational journeyProgram  intro,  familiarizationGoal  setting,  Aligned  motivesExperienced  successReinforced  lifestyleGets  educated  on  nutrition,  healthy  cooking,  meal  plans.  Begins  moderate  exercise  regimen.Margie  accompanies  Sam  on  daily  walks.  They  integrate  new  diet  patterns.  Attends  yoga  and    relaxation  class.  Sam  monitors  progress  on  mobile  device.  Bioinformatics  show  improved  cholesterol  levels,  heart  rate  reduction,  weight  loss.  Their  children  note  the  changes.Key  goals  are  attained.  Both  Sam  and  Margie  sustain  new  diet  and  ^itness  patterns.  Risk  factors  are  signi^icantly  reduced.Musts Reduce  weightHeighten  activityBetter  manage  stressShoulds Acquire  trainer/partnersBroaden  social  circleImprove  self-­‐imageEnlist  family  supportDesires Gain  purpose,  af^iliationMustNotsContinue  fast    food  patternRemain  sedentaryGive  up,ignore  condition“Sam’s” Health Requirements5. Researching & Modeling the User/Patient: “Sam”
  • 15. Patient  proEile:• 48  yo  single  mom  of  three• Children:  Ivy  17  (HS);  Eva  23  (college);  Robert  25• Nurse  at  physician’s  of^ice,  Loves  her  job• Socially  active,  outgoing  with  friends,  community  groups• Good  cook,  loves  entertaining  but  rarely  has  time• Facebook  user:  checks  up  on  kids,  friends• Cares  for  aging  parents  living  nearby  (early  dimensia).  Filing  guardianship  papersIllness  proEile:• High  risk  for  diabetes.  Overweight.  High  blood  pressure,  cholesterol.  Knee  problems• High  calorie  diet,  “grazer”.  Former  Weightwachters  success  story.  Relapsed.  Deterred  from  doing  it  again.• Self-­‐doubts,  prone  to  depression15“Jill”diagnosedType 2 diabetesawareness relevance confidence satisfaction“Jill’s” transformational journeyProgram  intro,  familiarizationGoal  setting,  Aligned  motivesExperienced  successReinforced  lifestyleReceives  her  MyWellness  device.  Visits  with  wellness  coach.  Assesses  life  and  wellness  priorities.  Enlists  help  of  friends  and  family.Sets  modest  goals.  Schedules  weekly  yoga  class,  Weight  Watcher  class,  Healthy  Cooking  class.  Begins  tracking  ^itness,  food  points.Begins  Jazzercise  class  with  two  friends.  Exceeds  all  goals;  publishes  her  success  to  Facebook.  Sets  new  goals.  Buys  new  wardrobe.Goals  are  within  reach.  Busy  with  work;  caused  her  to  back-­‐slide,  but  she’s  back  on  track.  Daughter  is  now  attending  classes  with  her.      Musts Reduce  weightIncrease  activity  levelLower  blood  pressureShoulds Better  manage  stressIncrease  independence  and    self-­‐esteemDesires Enlarge  social  circleMustNotsGiven  in  to  depressionGain  more  weightOver-­‐rely  on  children“Jill’s” Health Requirements5. Researching & Modeling the User/Patient: “Jill”
  • 16. 16User Experience Scenario 2: “‘Eleanor’s’ Lifestyle Change”Eleanor’s Lifestyle ChangeAnother user experience scenario*tells the story of “Eleanor”, a 65year-old widow diagnosed as pre-diabetic now adjusts to new lifestylehabits in order to feel better and tolower her disease risk.https://vimeo.com/62761997*  Product/service  user  experience  prototypes  help  teams  see  the  context  in  which  a  new  idea  or  offering  might  play  out  in  the  marketplace  and  in  the  lives  of  customers.  These  advance  snapshots  enable  decision-­makers  to  assess  the  merits  of  a  value  proposition,  assess  its  implications  and  make  better  a  priori  business  decisions.
  • 17. 17Social  trends  involving  health  accountability,  and  particularly  increased  ability  among  consumers  to  quantify  and  track  ^itness  and  health  factors  fosters  increasing  consciousness  to,  and  control  over,  one’s  health.6. Market Analysis: Consumer Behavioral Health Trends
  • 18. 18Bayer Contourgap value transferPersonal Health Devices Consumer Market MapFitness  and  health  tracking  apps  are  currently  focused  on  the  consumer  market.  There  is  a  sizable  gap  between  that  consumer  market  to  the  medical/health  care  industry.Market Analysis:
  • 19. The  quality  of  user  experience  in  many  personal  medical  devices  is  currently  poor:  informational,  but  often  burdensome,  confusing  and  even  intimidating.  Hardly  lifestyle-­‐friendly.  Tracking  and  monitoring  information  such  as  glucose  levels  and  nutrition  feel  very  clinical.  Currently,  the  focus  seems  to  be  more  about  journaling  data  than  changing  or  improving  the  quality  of  experience,  behavior  or  lifestyle.19Market Analysis: Current Device UX vs. Benchmark UX In Personal Health Devices
  • 20. • THE  USER,  with  a  prescription  from  his/her  physician,  downloads  the  branded  app  suite  from  a  managed  care  provider.  She  gets  acquainted  with  the  app,  sets  very  basic  goals,  and  begins  to  use  basic  functions• THE  PROVIDER  offers  programmatic  support  (e.g.,  user  group  sessions,  counseling,  documentation,  social  networking  and  feedback,  troubleshooting)  to  users  to  build  competence  and  lead  to  more  advanced  levels.• THE  PHYSICIAN  follow-­‐up  with  patient  in  subsequent  visits  offers  professional  support  and  encouragement.• THE  EMPLOYER  wellness  program  reinforces  program  goals  and  incentivizes  employee  success• THE  BRANDED  APP  PROVIDER  continues  to  upgrade  product  platform,  improves  usability.  Premium  custom,  personalized  services  could  be  offered  to  “super  users”208. Business Modeling: Stakeholder MapsThe branded product/service suitePhysiciansManaged CareProviderCorporate WellnessProgramsPatients/Insured Liveseffectiveness isassessed andprogram is tweakedto maximizeperformancecontinue toupgrade andexpandfeatures
  • 21. 21
  • 22. The  Suite:  A  web  and  mobile  app  that  focuses  on  improving  the  health  of  people  with  chronic  disease.  This  app  suite  will  work  to  condition  new  behaviors  surrounding  ^itness,  nutrition  and  stress  management.  These  new  behaviors  will  result  in  increased  health  and  reduced  cost  of  care.  The  suite  dashboard  available  by  login  displays  app  engagement  analytics  and  health  impact  in  aggregate  (to  protect  privacy).  App  engagement  measurements  are  used  to  help  project  health  improvement  and  projected  cost  savings.22Business Modeling: Solution Strategy1.  Incentivize  and  enable  healthy  consumer  behavior  vis-­‐a-­‐vis  stress,  nutrition  and  ^itness,  thereby  improving  health  and  lowering  chronic  disease  risks.2.  Promote  individual  accountability  for  health  insurance  biometric  tracking.3.  Adapt  consumer  Eitness  product  innovations  to  the  medical  side  of  the  market9. The Consumer App: Dashboard Interface Concept A
  • 23. 23User Experience Scenario 3: “Joe’s Osteoarthritis”Another user experience scenario*featuring “Joe”, a 25 year-old artist/printmaker learning how to bettermanage his health and hisosteoarthritis.http://www.youtube.com/watch?v=u1KouGJitaEMyHealth: “Joe’s Osteoarthritis”*  Product/service  user  experience  prototypes  help  teams  see  the  context  in  which  a  new  idea  or  offering  might  play  out  in  the  marketplace  and  in  the  lives  of  customers.  These  advance  snapshots  enable  decision-­makers  to  assess  the  merits  of  a  value  proposition,  assess  its  implications  and  make  better  a  priori  business  decisions.
  • 24. Slide-­In  NavigationWhen  a  slide-­‐in  navigation  icon  is  touched  on  the  top  level  navigation  bar,  this  menu  "slides"  in  from  the  left,  pushing  the  current  content  to  the  right.  This  navigation  allows  the  user  to  quickly  navigate  to  anywhere  within  the  app,  down  to  the  secondary,  tabbed  navigation  level.  When  there  are  more  items  to  navigate  than  can  ^it  on  one  screen  the  navigation  items  scroll.Home  ScreenThe  home  screen  offers  a  quick  glimpse  of  status  and  progress  The  three  upper  circles  represent  the  three  apps  within  the  suite  application.  Each  circle  show  current  point  information,  and  touching  a  circle  sends  the  user  to  that  app.  The  face  indicates  status  and  progress  toward  each  goal.  The  lower,  scrollable  section  is  con^igurable  by  the  user  and  can  contain  a  log  of  current  events  (shown),  a  photographic  timeline,  inspirational  photos,  etc.  249. The Consumer App: Top-Level Device UI Concept Wireframe, Navigation and InteractionNavigationPast  the  home  screen,  the  top  level  navigation  is  always  present.  This  bar  provides  the  title  of  the  current  section,  the  name  of  the  user  and  an  icon  to  activate  the  slide-­‐in  navigation.  The  secondary  navigation  allows  each  app  section  a  way  to  divide  content  and  functions  with  a  common  tabbed  approach.
  • 25. 1.  The  app’s  main  navigation  bar  lets  the  user  tab  through  the  various  screens  in  the  nutrition  app  (home  screen,  meal  planning,  statistics,  favorites).2.  "Enter  a  Meal"  lets  the  user  input  meal  info,  or  plan  future  meals.  3.  "Point  Circle"  gives  the  user  a  quick  reference  to  their  daily  point  count.    The  point  count  correlates  to  a  simpli^ied  dietary  system  that  represents  the  nutritional  goals  in  an  understandable  way.4.  “Tracking  Table"  lets  the  user  check  overall  monthly  data.    The  "Points",  "Pounds",  and  "Both"  buttons  offer  alternate  views  of  data.  Nutrition  App:  Top  Screen  Concept  Wireframe2510. The Nutrition App: FeaturesPhysician  Connection/PrescriptionHealth  Information  ImportedExisting  Health  StatisticsDietary  GoalsCommunicate  Updated  StatisticsOne-­Week  Nutrition  AssessmentPatients  Have  Time  to  Learn  AppWhat  are  the  Patients  Habits?What  are  the  Patients  Preferences?Makes  Tracking  EasySimple  Point  SystemPhoto  Assessment  of  FoodAsk  Siri  If  Your  Meal  FitsSave  Favorite  MealsSuggests  Changes/Tracks  ProgressSuggest  A  MealEnter  a  MealPoint  LimitsPhoto  Log  of  Food  ChoicesPhoto  Log  of  Body  ImageOffers  Goal  RemindersVisual  RemindersAlerts  when  Points  are  ExceededCongratulate  Patients  When  On  TargetAbility  to  Connect  SociallyAbility  to  Plan  Meals/Grocery  List
  • 26. Presses  "Enter  a  Meal" Presses  "Let  Me  Tell  You" Says,  "Chipotle  Burrito  Bowl" Presses  "Yes"  to  continue.26The  Nutrition  App:  Use  Case  Scenario  Concept:  “Sam”  visits  Chipotle  Customizes  meal  and    presses  "Add"Presses  "Log"Pop-­‐up  alerts  user  to  options
  • 27. 2711. The Stress Management App: Key FeaturesA.  Tracking  and  RecordingHeart  rateBreathing  B.  Stress  Management  TechniquesBreathing  exercises  GamesCalming  musicInformation  and  Tips  C.  Anticipating  and  RedirectingPlanning  and  SchedulingRemindersA.  Tracking  and  Heart  Rate  and  Breathing• The  highly  sensitive  camera  on  a  smartphone  is  able  to  detect  the  slight  change  in  skin  color  during  a  heartbeat.• For  the  app  to  begin  tracking  heart  rate,  the  user  will  gently  place  the  pad  of  their  index  ^inger  on  the  camera  lens  of  the  phone.• Continue  to  hold  hand  still  until  the  app  can  get  an  accurate  heart  rate  reading.• The  result  will  indicate  whether  the  stress  level  is  low,  average,  or  high.• A    result  page  will  follow,  detailing  the  level  of  stress.• This  page  will  also  allow  the  user  to  enter  in  where  the  sources  of  stress  are  in  their  life.• This  data  will  be  recorded  and  saved  for  viewing  in  the  Aggregate  of  the  Data  section  of  the  app.SOURCES: Web MD, Human Physiology (McGraw-Hill, 7th edition), The American Instituteof Stress, Mayo Clinic, eHealth MD, National Heart, Lung and Blood Institue, AmericanHeart Association, Yale Medical School
  • 28. Recording  Your  Data• The  data  derive  both  from  breathing  exercise  and  heart  rate  tests.• Presents  a  "big  picture"  of  recorded  stress  levelsGraphing  Your  Data• The  app  graphs  users  past  and  current  stress  levels  and  heart  rate• The  app  offers  a  look  at  the  past  week  or  month  of  stress  levels  and/or  heart  rateIdentifying  Sources  of  Stress• Helps  user  identify  issues  causing  stress,  and  such  awareness  enables  user  to  make  changes  to  improve  coping  skills  and  life  balance.28A.  Recording  Heart  Rate  &  Breathing1.  Controlled  Breathing  can  reduce  stress  levels  by  syncing  inhalation/exhalation  with  you  current  heart  rate.  2.  Simple  games  can  distract  from  stressful  situations  and  activities  and  create  a  calming  environment.3.  “Stress  Tips”  offers  information  to  help  user  become  more  conscious  to  the  causes  and  effects  of  stress  in  daily  life.    4.  "Calming  Sounds"  enable  user  to  tune  in  and  relax  while  performing  other  activities.  Music  Therapy  can  be  helpful    coping  and  easing  the  progress  of  some  illnesses.  B.  Stress  Management  TechniquesSOURCES: Web MD, Human Physiology (McGraw-Hill, 7th edition), The American Instituteof Stress, Mayo Clinic, eHealth MD, National Heart, Lung and Blood Institue, AmericanHeart Association, Yale Medical School
  • 29. Planning  &  Scheduling• Conscious  awareness  about  past  and  present  stresses  is  bene^icial,  but  stress  management  is  also  about  anticipating  and  preparing  for  inevitable  stressful  situations  (e.g.,  deadlines,  tight  scheduling,  over-­‐booking,  holidays).Reminders• A  smart  stress-­‐management  app  can  sync  with  your  calendar,  look  at  your  upcoming  schedule,  and  check-­‐in  with  the  user  during  tightly  scheduled  and  stressful  times,  reminding  her  to  get  sleep,  take  a  break,  meditate  or  reschedule  accordingly.  29C.  Anticipating  and  Redirecting  StressSOURCES: Web MD, Human Physiology (McGraw-Hill, 7th edition), The American Instituteof Stress, Mayo Clinic, eHealth MD, National Heart, Lung and Blood Institue, AmericanHeart Association, Yale Medical SchoolThe  stress-­management  app  aims  to  support  the  user’s  long-­term  health  interests  and  life  balance.
  • 30. 3012. The Fitness App: RequirementsFitness  Setup  Wizard  Use-­Case  Scenario:  “Jill”  sets  up  her  Fitness  App  and  does  a  workout”The  Fitness  App  employs  a  ^itness  wizard  to  roughly  assess  a  user’s  overall  ^itness  level.    It  begins  by  asking  the  user  to  do  some  basic  physical  activities  and  answer  some  questions.  Q:  How  often  do  you  run?Q:  Can  you  lift  5/10/15  lbs?Q:  How  long  can  you  balance  on  one  foot?  Q:  How  long  can  you  run  or  do  a  vigorous  walk?Q:  Can  you  touch  your  toes?Q:  What  is  your  height?  weight?Impact:• Cardiovascular  Fitness• Muscular  Strength• Balance• Flexibility• Body  Composition  New  personalized  homepage  for  ^itness  appReview  and  modify  points  for  daily  goalFitness  App  Setup Wizard  Queries Setup  Completion
  • 31. 31The  Fitness  App  Use-­Case  Scenario:  “Jill”  does  a  workout“Jill”  begins  her  workout  by  selecting  from  three  Eitness  instructors.  Then  she  selects  a  series  of  exercises.  For  each  exercise  there  is  an  optional  “how  to”  instructional  video  clip.Do you have timeto do more?10 LungesMore No13/2017/2010/2019/2020/20She  check  her  goal  and  sees  workout  historyAfter  completing  her  workout  “Jill”  clicks  to  review  progressOn  completing  the  workout  the  app  offers  option  for  moreShe  selects  jumping  jacks  and  watches  the  optional  video  demo“Jill”  selects  from  a  variety  of  routine  exercises
  • 32. 32User Experience Scenario 4: “Adam’s Resolve”A final sample UX video* from“Adam”, a 24 year-old shocked bynews of his high cholesterol levelsand increased risk for diabetes.“Adam’s Resolve”http://www.youtube.com/watch?feature=player_detailpage&v=gL8oy16hYXU*  Product/service  user  experience  prototypes  help  teams  see  the  context  in  which  a  new  idea  or  offering  might  play  out  in  the  marketplace  and  in  the  lives  of  customers.  These  advance  snapshots  enable  decision-­makers  to  assess  the  merits  of  a  value  proposition,  assess  its  implications  and  make  better  a  priori  business  decisions.
  • 33. 13. Bibliography Fogg,  B.  (2009).  A  behavior  model  for  persuasive  design.  In  Proceedings  of  the  4th  International  Conference  on  Persuasive  Technology  (pp.  40:1–40:7).  New  York,  NY,  USA:  ACM.  doi:10.1145/1541948.1541999Keller,  C.,  Fleury,  J.,  &  Rivera,  A.  (2007).  Visual  Methods  in  the  Assessment  of  Diet  Intake  in  Mexican  American  Women.  Western  Journal  of  Nursing  Research,  29(6),  758–773.  doi:10.1177/0193945907304471Kong,  A.,  Beresford,  S.  A.  A.,  Alfano,  C.  M.,  Foster-­‐Schubert,  K.  E.,  Neuhouser,  M.  L.,  Johnson,  D.  B.,  …  McTiernan,  A.  (2012).  Self-­‐Monitoring  and  Eating-­‐Related  Behaviors  Are  Associated  with  12-­‐Month  Weight  Loss  in  Postmenopausal  Overweight-­‐to-­‐Obese  Women.  Journal  of  the  Academy  of  Nutrition  and  Dietetics,  112(9),  1428–1435.  doi:10.1016/j.jand.2012.05.014Leiphart,  Jeffrey  M.  HIV  InSight  Knowledge  Base,  University  of  California,  San  Francisco.  http://hivinsite.ucsf.edu/InSite?page=KBRoberts,  C.  K.,  &  Barnard,  R.  J.  (2005).  Effects  of  exercise  and  diet  on  chronic  disease.  Journal  of  applied  physiology  (Bethesda,  Md.:  1985),  98(1),  3–30.  doi:10.1152/japplphysiol.00852.2004LIVESTRONG.COM,  The  Effects  of  Poor  Nutrition  on  Your  Health.  (n.d.).  Retrieved  December  9,  2012,  from  http://www.livestrong.com/article/31172-­‐effects-­‐poor-­‐nutrition-­‐health/Thorpe,  K.  (2007).  An  Unhealthy  Truth:  Rising  Rates  of  Chronic  Disease  and  the  Future  of  Health  in  America  [PDF  document].    Retrieved  from  Capitol  Hill  Brie^ing:  http://www.prevent.org/data/^iles/initiatives/thorpeslides11-­‐30-­‐07.pdfSperry,  L.  (2008).  *Treatment  of  Chronic  Medical  Conditions,  Len  Sperry,  American  Psychological  Assn.World  Health  Organization  (2005).    Ten  Facts  About  Chronic  Disease.    Retrieved  from  http://www.who.int/features/fact^iles/chp/10_en.htmlWu  SY,  Green  A.  (2000).  Projection  of  Chronic  Illness  Prevalence  and  Cost  In^lation.  Santa  Monica,  CA:  RAND  Health.33
  • 34. PRESCRIPTIVE APPS: Delivering therapeutic behavioralcare to chronic disease patients, enabling personalizedself-management ofdiet, fitness and stress.Michael Eckersley, PhDDesigning  a  wellness  economy            THE PRESCRIPTION MOBILE APP: Productizingbehavioral care for people managing a chronicdisease and needing behavioral therapeuticsupport34This work is licensed under a Creative Commons Attribution 3.0 Unported License.