Knowsley Health Hub was a hyperlocal health app for iOS & Android delivering health engagement to a localized population in Knowsley, Merseyside.
It was developed as a greenfield innovation project with a social purpose to address the problem of low health engagement in localised populations within the NHS.
Knowsley is one of the most deprived regions in England with some of the poorest indicators for health in the country.
On average people in Knowsley die younger & have more chronic conditions than the national average.
IDEATION, DESIGN, EXECUTION
I was responsible for the concept & execution. This included user research & customer discovery for the concept, along with all creative work – UX & graphic design – authoring the technical specification & sourcing & management of the development. I also completed all video capture, editing, audio & site development.
I worked with a clinician from the local area to pitch the project & secure funding.
To understand the back-end clinical systems & networks, I was lucky to have been provided working space in the NHS Health Informatics provider offices for that region, as well as having day-to-day access to space in local GP surgeries.
I worked closely within the local community – both patient side & clinician side – to understand the needs & desires of both from such an app. Working hard to build close relationships within the local community provided me the privilege of being assimilated enough, even as an outsider, and be entrusted with recording their experiences of health issues on video.
ENGAGING AUDIENCES IN HEALTH INFORMATION
The aim of the app was to deliver engaging information on the health services to Knowsley Citizens.
FEELINGS OF EMOTION AROUND HEALTH INFORMATION
To do this, the presentation needed to reduce anxiety around the information. Instead of being presented as an “illness” information resource, it needed to be presented as a positive source of “well being” information.
In addition, levels of literacy in the region were low, with the local council targeting a reading age of 8 in its publications.
THE ROLE OF TRUST
The first step to this was to engage the audience. This was a challenge as the app needed to build trust & credibility with a demographic who had shown evidence of suspicion & fear of “authority” (with health providers commonly seen as authoritative figures).
BEING LEAN & AGILE
There was quite a limited budget for the build of the app. The technical architecture needed to remain nimble & agile to be responsive to feedback from the audience. The projected needed to be truly lean & agile.
EXAMINING THE DATA
I first started by looking at demographic information for the area to get an understanding of the intended audience.
I also looked at health related statistics for the area which quantified the prevalence of particular conditions & scored them against the national average.
BRINGING THE DATA TO LIFE
I also spoke to local GPs & other health care professionals to gather anecdotal evidence of the approach to healthcare locally. It was only through these human eyes than I began to get a real understanding of the impact of the levels of deprivation in the area & how it affected health in every way.
PSYCHOLOGY OF BEHAVIOUR CHANGE IN HEALTH
My interpretation of the insights was further enhanced through my research into behaviour change within the health sphere.
In particular much research had been conducted & published by The Kings Fund which was easy to read & digest. When I looked into academic research although there was much on behaviour change. there was a distinct lack of research into the particular area of low socio economic groups. The research that I found related mainly to diet, but not other areas of health.
“People often view health choices made by those lacking money as poor personal decisions…in fact, people’s health choices strongly reflect the environments in which they live, work and pray…Rather than calling a patient who hasn’t followed advice to improve health habits noncompliant, really helping him would require making suggestions that account for the resources available in his environment.”
Amy Harley, Ph.D., MPH
UNDERSTANDING THE AUDIENCE – MORE THAN NUMBERS
I held several co-creation sessions in the community centred around the topic of health information. This included visiting various community groups such as Children’s Centres, breastfeeding groups, carers groups and local health centres.
I also looked at the provider perspectives & visited clinicians such as diabetes community support providers, sexual health services providers & cardio vascular rehab providers.
SURVEYS & QUESTIONNAIRES
In addition to my qualitative research, I undertook quantitative research in the form of an online survey administered through Survey Monkey.
My inquiry centred around attitudes & awareness to health information & resources both off & online. I looked at barriers to engaging with health content & familiarity with existing digital health resources such as online records & tools.
MOTHERS AS CARE NAVIGATORS
My user research resulted in the creation of a number of personas.
The personas were reflective of the bias of mothers acting as care navigators of family units.
SETTING A VISION: DEFINING UX VALUES
In order to capture the intrinsic vision for the UX, I created set of core values.
This set was very useful during the design process as a guide to navigating the many decisions that needed to be made.
Fun & Playful
Rewarding & Engaging
Exciting & Challenging
Competitive & Collaborative
Social & Sharable
“Put your hand on a hot stove for a minute, and it seems like an hour.
Sit with a pretty girl for an hour, and it seems like a minute.
MHEALTH APPS – WHAT’S OUT THERE ALREADY
As all UX is judged in context, I undertook research to understand what apps were already available & which apps were doing well. I looked into segmented app industry reports, as well as app store rankings.
Luckily I stumbled onto some fantastically thorough research from Monitor Deloitte & Research which detailed the current status & trends of the mHealth app market with some interesting insights.
It highlighted the distinction between app segments – e.g. “fitness” apps & “medical” apps. Within the health segment, it showed that the majority of apps either dealt in detail with 1 particular health issue – many of which were chronic conditions such as diabetes – or dealt with one aspect of the patient journey such as prevention or diagnosis, but non provided a breadth of information across the treatment cycle.
HOW TO SPEAK TECH TO NON TECHNICAL AUDIENCES
Communicating the ideas to audiences (often NHS representatives) who mistrusted & felt disabled by technology required carefully breaking down into a series of more familiar formats such as presentations, specifications.
A new format which found particular success with these audiences were storyboards, as they broke down the concepts in more familiar terms, using keywords from their own language & day-to-day settings.
CAPTURING & COMMUNICATING EARLY IDEAS
After some additional feedback, I created some early low fi (block level) wireframes which documented the basic functionality & structure.
SOURCING MVP CONTENT
One of the biggest challenges for any health related apps is sourcing trusted content.
The app was built to use syndicated content from the NHS to populate any prescriptive areas of the app.
This solved the problem of providing reliable & up to date content within the app, as well as reassurances to commissioners on the quality of the content.
QUICK & DIRTY PROTOTYPES
EARLY & OFTEN FEEDBACK
In order to get early feedback on the prototype, I needed to produce something reflective of the core values.
In order to do this, I needed to move away from black & white representations & introduce some colour, icons & graphics.
I put together a colour palette which reflected a guided architecture through the app. I created a quick prototype in Marvel App & did some guerrilla user testing in GP waiting rooms & at some community groups sessions.
After receiving feedback I restructured some screens & changed a some of the user flows. This feedback helped me to understand how to prioritise features for an MVP.
The next step was to go out to the market & seek quotes for the concept.
I used the screens from the prototype to help illustrate the MVP specification.
The spec outlined all functionality including back-end elements such as CMS requirements, API integrations, analytics, & futureproofing information.
OUT TO THE DEVELOPMENT MARKET
Sourcing quotes for the work was a very interesting experience & provided a large variety of quotes.
I contacted a range of app build companies in a range of locations, including Poland, Romania, America & the UK.
The quotes I received varied by location, with the most expensive quotes coming from the UK.
I interviewed each to learn about their process & approach.
A SCALABLE MVP BUILD LEAN & AGILE
With a more informed understanding of the costs involved to build each type of feature, I re-worked the backend architecture so that it was cheaper to build & enabled future content updates running from a WordPress backend & a CMS for push messages.
Using WordPress also provided the ability to add modular functionality as needed at little extra cost.
The system was architected in such a way that it would be scalable if needed to roll out to other areas with a custom skin.
PHASE 1: MVP SITEMAP
STARTING LEAN & AGILE
On the front-end, I had reduced the amount of functionality to target particular “self-service” digital tools the local health commissioners were looking to promote such as a digital service finder, condition checkers, help with online appointment booking & survey functionality.
I used content sourced from syndicated NHS content feeds with key messaging delivered via hyperlocal format – referring to local places, events, & utilising video of local people delivering messages to build trust & credibility.
The app contained user customisation settings, whereby users could indicate their preferences on the type of information they would receive.
The options were based on public health research on the area about the most common health conditions & issues where it was underperforming against the national average.
The core content was presented in a newsfeed format, which presented bitesize snippets of information linked to full articles.
CROSS PROMOTING INFORMATION
The newsfeed then linked to full articles, which were cross promoted with information on self-service tools, local health services & wider educational content to encourage further knowledge & engagement.
The development team was small & I worked with them on a day-to-day basis with the to manage the build.
I managed all developer & server accounts. I acted as QA for the development & used Asana to track feature builds & bugs.
I provided all image files & additional styling guidance as needed.
STORE SUBMISSION – LESSONS LEARNED
WHAT NOT TO DO WHEN YOU SUBMIT TO THE APP STORE
Submitting the app to the Play & iOS stores was an interesting process & I learned a lot about the stages & timeframes involved from completing the process myself.
I created the developer accounts & managed access privileges. I wrote the app descriptions & created the graphics.
A mistake which tripped me up was using a generic device frame in one of the tour images submitted as a preview shot to the App Store.
Although the shot was clearly a cartoon style representation, the entire submission was rejected because the shot did not reflect an Apple device.
This delayed the release & I had to quickly rebuild that screen to show an Apple device.
MARKETING THE APP
As well as building a promotional website, I created a set of print material including banners, leaflets & posters.
Alongside this, I designed & sourced a set of custom promotional merchandise consisting of pens, mugs, balloons, sticky notes & t-shirts.
BRINGING A DESIGN TO LIFE
In parallel with the design & development work, I went out into the community to source & create content. The content centred around short videos of 2 types.
The first was from community members speaking about their experiences of health issues & health services.
The second was a series of informational snapshots presented by clinicians such as cardio rehab nurses & community diabetes team members.
Both videos presented inspirational, but relatable, information about health topics & local health services. The information was presented in the language & accent of the local population, making it easier to understand & more relevant & relatable to the target audience.
The production of the videos was truly lean & agile, capturing volunteers in the moment, on iPhone camera. The result was that the low production value video footage created an intimate & more honest feel for the information.
The information was interspersed with NHS content, ensuring a variety of content. While the video content was all descriptive of health issues & services (that is, it did not contain any advice), the NHS content was more prescriptive, containing up to date advice & recommendations to users.
This reduced any risk of information going out of date, as the NHS content was dynamic in nature & periodically reviewed & approved by the NHS to ensure it was correct & current.