Rehapp (Healthcare App Challenge)

[In collaboration with Yasmin Diederiks, Michael Waltrip and Taha Zafar]

Challenge:

HFES invites all students to participate in the “Mobile Health Applications for Consumers” Design Competition in conjunction with the 2017 International Symposium on Human Factors and Ergonomics in Health Care.

Objectives:

Showcase the application of human factors/ergonomics (HF/E) methods and design principles to the design of a mobile health application for consumers (health-care recipients) or their nonprofessional support network (informal caregivers and community). Justify how the HF/E approach to such an application can lead to a useful, usable, and satisfying user experience while improving patient outcomes such as knowledge, safety, adherence, or health.

Scope:

Applications should be designed for use by nonprofessional health-care consumers and/or their support network. Such users include patients and informal caregivers such as family members and friends. Applications designed for use by clinical professionals or other health system employees are out of scope for this competition. Applications should be mobile health software accessible via a mobile device, with an option to integrate it with hardware (e.g., wearable activity tracker, Bluetooth blood pressure cuff) and/or online services (e.g., Google Maps, Facebook).

Solution:

This is a sneak peek of a working prototype of Rehapp that will be submitted for the competition. Click on link to access it – https://marvelapp.com/11e9294?emb=1.

Introduction

Before getting into the literature and empirical support, we would like to illustrate our thought process in choosing a rehabilitation app. In brainstorming topic ideas, we were appreciative of the intentional ambiguity offered by the prompt. We first thought of creating an app that would track visits to the doctors and log all relevant information. However, we quickly became aware of the magnitude of such a pursuit and decided to focus on something more specific and tangible.

One group member was involved in physical therapy for an injury and brought up the idea of a creating an app that helps patients visualize and track their progress in the rehabilitation process over time. Thus, Rehapp was born. Our target population is patients who are actively involved in rehabilitation and our goal is for Rehapp to aid in the process by increasing compliance, subjective experiences, and helping to keep the patient engaged.

Reasons for noncompliance in rehabilitation are complicated and numerous. Sluijs, Kok, and van der Zee (1993) identified three main factors: “(1) the barriers patients perceive and encounter, (2) the lack of positive feedback, and (3) the degree of helplessness”. Additionally, the tracking of outcome measures creates problems of its own. Common reasons for noncompliance when using standardized outcome measures for rehabilitation are the result of the length of time required to complete them, the length of time for clinicians to analyze the data, and difficulty in a patient completing them individually (Jette, Halbert, Iverson, Miceli, & Shah, 2009).

Rehapp attempts to solve these issues in a number of ways. Rehapp demonstrates usefulness in the ability to log any physical or affective outcome measure (e.g. pain level, current mobility, distress, rehab-efficacy) and track changes over time. Rehabilitation professionals can use their discretion and offer advice regarding the measures (standardized or personal) that any given patient may track. Patients can enter data on their own time or can set Rehapp to prompt them at predetermined intervals as a reminder to log data (e.g. daily, weekly, etc.). Using simple and intuitively designed drop down menus, Rehapp can create graphs or charts that help patients visualize their past and projected progress on any selected variable over time. Another central component of Rehapp helps keep patients accountable in forming habits that facilitate rehabilitation by providing cues and tracking compliance. For example, Rehapp can track sleep habits as they aid in motor learning (Siengsukon & Boyd, 2009; Siengsukon & Boyd, 2015) or exercise compliance as it is critical to rehabilitation (Campbell et al., 2001). As mentioned, patients can opt to receive push notifications to their mobile phone that reminds or prompts them to engage in a behavior. As a means of visualization, similar to the tracking of outcome measures described above, Rehapp can illustrate to patients how often they completed desired habits over any specified time period. Lastly, Rehapp attempts to keep users engaged through gamification. Studies support that gamification can help in outcomes and engagement (Hamari, Koivisto, & Sarsa, 2014; Jacobs, Timmermans, Michielsen, Vander Plaetse, & Markopoulos, 2013). Rehapp can give users trophies and badges for completing predetermined criteria (e.g. sleeping 8 hours for 3 days in row, completing specific exercises at least 5 days out of the week).

Further, positive thinking can enhance health and well-being. Scheier and Carver (1993) explain people’s action are significantly influenced by their expectation about the result of their action. Individuals are more likely to persevere to achieve the desired outcome if they believe their goal is achievable. As a result, we include inspirational quotes in Rehapp to elicit a positive perspective about their rehabilitation experience to help users achieve their desired outcome.

Design

In the designing of Rehapp, our team implements various human factors principles to achieve the most intuitive and user-friendly interface for our audience. The process first involved determining precisely who our potential users would be, and how to best address each developed persona. As rehabilitation procedures occur across all stages of life, it was imperative to split the user base first by age to identify necessary assistive-based design choices. For example, it is key to use the simplest language and large font sizes to cater to both children (ages 9-12) and elderly users (65 and over), should they be part of the target audience (Becker, 2004). As our team began to break down possible reasons as to why each age group would require rehabilitation, what their goals would be during that process, and how Rehapp could help to achieve those goals, we managed to come up with both a design and functions that best universally address a wide audience.

Much like how diet-tracking applications serve to project weight-loss progress and advise accordingly, Rehapp attempts to achieve the same with healthcare. The rehabilitation process for any individual is one that needs constant monitoring, and healthcare patients may often be left in situations where access to a doctor or forms of knowledge and support are limited. Rehapp attempts to be that missing form of support for these individuals. Healthcare professionals and other individuals can only evaluate an individual in the moment that they are present. With a quantitative and qualitative tracking measure such as Rehapp, individuals are best able to gauge the physical pain and emotional history of a patient at a far more detailed and accurate level. This tracking data can be used as encouragement for the user to maintain their current rehabilitation program as opposed to dropping it. A number of studies provide contrasting evidence on rehabilitation dropout rates. In regards to cardiac rehabilitation, estimates range from and between 13 percent to 87 percent (as cited by Carmody, Senner, Malinow, & Matarazzo, 1980). With such diverse findings it is apparent that some treatments are more effective at reducing attrition than others. Rehapp aims to keep the dropout rates low.

In terms of the design, Rehapp utilizes the “In-Field Alignment” form structure for the input of user information. This design choice was made as it allows for a preservation of space and less interference with the visual design; symbols are utilized to combat the disadvantage of forgetfulness should the user accidentally delete the in-field text (Bojko & Schumacher, 2008).

To ensure features used in Rehapp are presented similarly to other mobile applications we evaluated different features from habit tracking, positive thinking, fitness, sobriety, and healthcare mobile applications. This evaluation allowed us to have a good understanding of how different features are usually presented in various kinds of applications. Nielson (1994) explains that one of the most important heuristics principles is to comply with standards of other, similar applications. We evaluated various applications which have similar features we had in mind to include in Rehapp such as visualizing progress in habit tracking and sobriety applications. We analyzed where would users expect to find features like reminders or how to indicate a task has been completed. This analysis assisted in ensuring Rehapp complies with users expectations of where they should look for features and how those features function. Further, by evaluating various applications we became more familiar with icons that are commonly used in mobile applications. Icons usually adhere to another heuristic principle of a match between the system and real world (Nielson, 1994). Example implementations in Rehapp include a gear icon representing settings or a pill icon representing medication.