How might older adults understand and adapt to their changing circumstances?
Washington University's Occupational Therapy Program approached our class to improve a screening tool intended to increase older adults' awareness of strategies and resources that may be used to age successfully. My team, which included a computer scientist, a business student, an architect, and myself, transformed their inefficient paper screener into an iPad app that provided real-time results and entered adults into an opt-in social network after the screener was complete. Visual Design by Emma Riley. Interaction Design by Emma Riley, Stephanie Mertz, Sam Landay and Lawrence Chen. Presentation deck written and designed by Lawrence Chen. Completed as part of Interaction Design: Understanding Health and Well-Being under the mentorship of Enrique Von Rohr.
Not sure what Occupational Therapy is? Don't worry, we weren't too sure either before this project began. According to the American Occupational Therapy Association, Occupational Therapists "help people across the lifespan to do the things they want and need to do through the therapeutic use of daily activities (occupations). Common occupational therapy interventions include helping children with disabilities to participate fully in school and social situations, helping people recovering from injury to regain skills, and providing supports for older adults experiencing physical and cognitive changes."
We began with a project brief from Washington University's Occupational Therapy (WU OT) program. The brief contained the guiding question, "How might we empower older adults to make better decisions and healthy choices about what leads to successful aging?"
We were also provided with copies of the paper screener that WU OT wanted to improve, and a paper detailing their long-term goals for the program. The original screener, shown below, was 26 pages long and appeared to be an amalgamation of several different assessments.
Meeting with Pat and Robin
After reviewing the materials, we had a better understanding of WU OT's goals for the screening tool, but we were unsure how a screener could do all that they wanted it to, and we were unclear what problem they were trying to solve. We met with Pat Nellis and Robin Hattori from WU OT in person to gain further clarity.
Insight: Larger audience than stated by Robin and Pat
We realized after talking to Pat and Robin that the screener was not just for adults experiencing health issues. They wanted the screener to serve as a tool for adults across a wide range of health levels and ages, from ages 50 all the way to 100 or more. This meant that ideally the screener would be flexible, tailoring questions to individual participants.
Insight: Didn't want the screener to be deficit focused
Robin and Pat emphasized that they did not want the screener to be deficit focused. Aging is a sensitive and frightening topic for many of the adults they deal with. They wanted the screener to provide opportunities, not just point to limitations. This insight drove my decision to give the screener a persona and to make the screener feel more friendly.
Insight: Meant to work as a research tool
Lastly, we learned that Pat and Robin wanted to use the screener as a research tool. Because the screener was on paper, individual Occupational Therapists had to record the data by hand, which slowed down the entire process. This impediment was a major motivator for transferring the screener to digital.
After discussing the screener with Robin and Pat, we had a better understanding of the overall problem: many older adults stop participating in activities they once enjoyed due to the limitations associated with aging, which creates a positive feedback loop of greater limitations and fewer activities. In order to tackle this problem, older adults need to be aware of what lifestyle choices and activities want to prioritize in their lives, they need to be aware of the limitations that prevent them from making those choices (could be financial, physical, mental, social), they need the tools to overcome or adapt to these limitations, and they need to take action.
We believed that the screener was currently solving steps one and two of the problem, if inefficiently, but failed to achieve steps three and four, arguably the most important and most difficult parts of the problem to solve.
In preparation for the task ahead, I researched different practical approaches to problem-solving, from ethnography to design thinking to business strategy.
Meeting with Linda
Next, we sat in on an interview with Linda, an Occupational Therapy patient, and watched an Occupational Therapist named Lisa guide her through the screener. Because there were four people on our team and four people from WU OT, we each chose a different person to observe during the interview.
Insight 1: There is a fear around aging; knowledge is empowering
Even though Linda was in excellent health, she feared the screening would reveal signs of memory loss. The screening minimized those fears and motivated her to take up new activities.
Insight 2: Client-screener interactivity promotes positive experience
Linda's interaction with the Occupational Therapist made the process friendlier and easier to understand. We didn't want to lose this interaction in transitioning to digital.
Insight 3: Diversity of activities is enjoyable
Though the we feared the diversity of assessments would make the screener feel unfocused, Linda enjoyed the variety of physical and mental activities involved.
Insight 4: Few areas in screening to give feedback or reflection
In some portions of the screener, the Occupational Therapist was testing Linda, and receiving no feedback on these assessments was frightening to Linda. The Occupational Therapist typically gave Linda encouraging feedback, but the screener did not include feedback on its own.
Insight 5: Scheduling conflicts and lack of friends with similar interests prevent taking action
These were the reasons Linda most often gave for stopping the activities she once enjoyed. It wasn't that she wanted to stop them, but that she didn't have anyone to do them with.
Insight 6: Lots of notes written in the margins
We realized that copying and pasting the questions wouldn't be enough to match the digital to the paper experience. We needed to offer Occupational Therapists a means to take notes within the screening application, lest we lose important information.
Insight 7: Scoring does not necessarily reflect the questions
In one instance, the Occupational Therapist asked Linda to rise from a chair and walk to a line 10 feet away from her. Though it appeared to be a test of walking pace, the Occupational Therapist was actually observing how easily Linda rose from her chair.
Insight 8: Inefficient process flow resulted in repeated questions
By the end of the screening, the Occupational Therapist was able to predict many of Linda's answers to the questions based on her previous answers. We wanted to eliminate these inefficiencies in the digital application.
Insight 9: Disjointed questions varied in tone and scale
Some of the questions were filled with jargon, some were casual, and others were distanced and formal.
Insight 10: Unclear explanations of the scales
Because the screener combined multiple assessments, each scale was different. Some ranged from 1-5, some from 1-3, and others ranged from A to E.
Insight 11: No one method to combine results
The varying scales of the different assessments within the screener meant that Linda couldn't receive a comprehensive health report. Instead, she received 8 separate scores that didn't have a shared language.
Though our meeting with Linda led to breakthrough insights, we knew it would be a mistake to base decisions on her profile alone since we wanted the screener to serve a wide variety of users. Therefore we developed four personas with diverse demographic information across the spectrum of health to offer a more representative picture. We began by giving each persona a health score. The healthiest persona received a score of 2, indicating health, across all wellness categories. The unhealthiest persona received a score of 1, indicating unhealthiness, across all wellness category. The two additional personas filled in the range of heath in between either extreme.
We used this framework to guide us and each of us chose one persona to develop more comprehensively. I built out Terrence Johnson's profile.
We knew that our solution was much more likely to work if we incorporated it into the everyday patterns of the users. In order to discover these patterns, Sam Landay and I performed an AEIOU exercise. We wrote down the Actions (everyday activities), Environments (places where actions happen), Interactions (people or things that actions happen to or with), Objects, and Users (preferences, values, biases, limitations) for each of the personas.
Because we wanted our solution to work for a diverse group of older adults, we noted the common themes across all four personas. Our discovery that every person checked their mail and had something to keep them busy weighed heavily into the solution we developed.