Introduction
This project involves designing a website onboarding experience and developing an app for learning and management. Cardiovascular diseases (CVD) are the leading cause of death globally, with hypertension as the top risk factor. Despite Canada’s progress in hypertension awareness and control, nearly 1 in 4 Canadian adults is affected. This highlights the urgent need to improve patient education, support self-management, and restructure health services for systemic change.
Collaboration
A collaboration between the Systems and Services Studio and a team of family doctors working in Sunnybrook Hospital to help patients with hypertension manage their blood pressure at home.
Managing Hypertension in the Current System
Education plays a crucial role in reducing unnecessary emergency room (ER) visits for hypertension. While evidence-based treatments and risk factor management can lower morbidity and mortality from cardiovascular disease (CVD), the variation in guidelines has created confusion, leading to inconsistent care. The CCHANGE initiative in 2011 aimed to unify these guidelines in Canada, resulting in 77 recommendations that support clinicians in providing comprehensive treatment plans.
A key issue has been the rise in ER visits for hypertension, which increased by 65% in Ontario between 2002 and 2012. Most of these cases end in discharge with no severe complications, suggesting that emergency care was often unnecessary. The widespread use of home blood pressure monitoring devices, while beneficial for managing hypertension, has likely contributed to this trend. Educating patients on when to seek primary care versus emergency care is essential to reduce ER visits, ensuring proper hypertension management without overwhelming emergency services.
Project's Framing
Based on the secondary research and discussions with primary stakeholders, three main challenges were identified. Those challenges could affect HTN self-management, home BP monitoring and eventually increase ED visits.
The research questions helped to identify and further examine these challenges: (1)What conversations take place when patients are advised by their primary care practitioners to monitor their BP at home? (2)What knowledge do patients have about interpreting BP readings? (3)How do users select self-measuring BP devices How do patients feel and respond to an elevated or low self-measured BP reading? (4) How patients' home BP readings are communicated or shared with the physician? (5)How do patients decide on what BP monitor device to purchase? (6)How comfortable are patients with using BP monitors or new technologies?
Upon the project's framing, secondary research and discussions, three emerging themes were created to help identify challenges.
Research Objective
The project's objective was to use the aforementioned insights that emerged from our initial research to explore possible design interventions that empower patients and support better BP monitoring and self-management at home, with an overall aim to reduce risk and anxiety around management and systematically reduce emergency visits. The patient experience journey demonstrates the possible effects of improving patients' education and providing support for the HTN self-management learning curve.
Research Question
To overcome, address the existing gaps and challenges, the project focused on understanding the different patients' lived experiences and activities at the various stages of HTN self-management at home; and the primary care physician-patient relationship. Thus, the design research question was set accordingly: How might we enhance the practice of home blood pressure monitoring as positive feedback for improving HTN self-management?
Stakeholders Analysis
The stakeholders' map includes all the actors that are affected or/and involved in the BP monitoring system. There are four levels of stakeholders identified around the end-user; care providers, community resources, HTN related industries, and society. All levels have been identified with respect to the relationship they have with the patient. Care providers are the closest to the patient and key actors in respect of patient’s BP monitoring, while society in the outer ring has less direct relationship with the user.
In addition, all of the stakeholders identified are placed according to their level of power in BP decision making and system change and their knowledge towards HBP monitoring and HTN.
Primary Research Overview
The overarching goal of our research is to learn about the personal narratives of patients with HTN, and physicians who treat HTN patients, to explore themes, validate assumptions, and uncover common attitudes or ideas amongst recruited participants.
Semi-Structured Interviews
A total of 8 semi-structured interviews were conducted. The sample included 6 patients and 2 physicians. Sample representation was varied as participants had diverse backgrounds and experiences. Participants were recruited by both Sunnybrook Health Sciences Centre and the project's research group. All interviews took place remotely using Zoom video conferencing.
Based on previously conducted primary research and secondary research, an interview topic guide was created to outline the process, set the stage for discussion, and highlight the various research outcomes for further focus. In order to allow reciprocity between participants and interviewers, as well as support participants, to freely share their own experiences and views on the topic, an interview topic guide was created. Additionally, guidelines created allowed for new themes to emerge from the participants' own experiences during the interviews; and helped in collecting and locating additional gaps found in the system.
Data Analysis
Thematic analysis was used to analyze the qualitative data gathered from our interviews. Notes and transcripts were examined and coded to identify commonalities or patterns of meaning. A deductive approach was used during previous cohorts' work analysis. The themes that emerged from this analysis helped to shape the project's ideation and design process.
Touchpoint Identification
Reflecting on the literature review, interview topic guide, interview data, and the thematic analysis, 6 major touchpoints were identified, which represented important interactions between patients, the system, and physicians. Each touchpoint represented a particular point of time in the HTN self-management journey. These points include: (1)First time of diagnosis, (2)BP Monitoring device, (3)Dealing with BP readings, (4)Emergency situations, (5) Follow-up appointments and (6)Current state position.
Each touchpoint represents an important point of the BP management journey for both the patient and physician. After conducting the data analysis, the patients and physicians appeared to have different perspectives and interacted along the touchpoints.
Therefore, creating 2 experience maps: one representing the patient’s journey from their perspective and the other focusing on the physician's point of view and their interactions was necessary to explore gaps and challenges differences and similarities.
Patients' Personas
Personas types were created based on the data collected from the interviews. To address the challenges' complexity, 2 main differences between the patients had to be addressed: (1)their experience and knowledge about HTN, and (2)being proactive or reactive when it came to making decisions and/or reaching out for help. Other data found that played an important role in disease diagnosis and management included: (1) the ease to control/manage one's BP and (2) accessibility to healthcare professionals and Resistant BP.
Patients' Persona Profiles
The data analyzed from the interview showed 2 types of patients, proactive and reactive. A proactive person is identified to focus on eliminating problems before happening. Some patients interviewed are proactive when it comes to learning about BP; they depend on several resources to read about their illness. They also look for alternative options when they don't get the help or support they needed. On the other hand, a reactive person is someone who takes action when an event happens. A reactive approach is based on responding to events after happening. Some patients might be hesitant to take actions, can be less active to look for educational resources, or seek advice unless there is a specific incident or an urgent need for that.
Physicians' Persona Profiles
2 types of physicians were identified from the data analysis conducted: proactive and reactive physicians. The proactive physicians provide a lot of education about HTN and BP management at home and explain BP readings. The reactive physicians might be hesitant to take actions, can be less active in providing education resources unless asked for it, or there is a need to take immediate action due to an urgent need for that.
The patient’s journey maps were created according to identified touchpoints. At each touchpoint, further understanding actions taken, the education received and the feeling that patients experienced were explored.
The physicians' journey maps were created based on the synthesized interviews data along the touchpoints identified. The touchpoint include elaborated actions taken by the doctors, the education that they give to their patients and their emotions/reactions during these moments.
Interactive
https://xd.adobe.com/view/c944dc21-9c34-4d7e-85c8-0b368ac9b3f6-9c17/?fullscreen
(Part 1: Team-Work-Project)
(Part 2: Individual-Work-Project)