NAAU – A Lean App To Support Depression Therapy.
The leading topic of the course "LEAN UX - Methoden und Mindset" lead by Prof. Marian Gunkel was "medical insights". This was mostly centered around the relationship between a doctor and his/her patient. In a design sprint in the beginning of the semester we explore the problems patients face in dealing with depression and its treatment.
The result of the design sprint was that patients need support outside therapy and simultaneously, that we would not seek to make a product that would replace therapy. Psychotherapy - as of yet - can not be automated.
Next we established a line of communication with both patient and therapist in order to get the right information to work with further. The first interview with the patient set the course for the entire project, as we learned that there was a certain order in which certain symptoms occur, for instance there was a point of crisis and there was the aftermath of said crisis. We based our thoughts and ideas around this structure and set constraints, such as the service should not annoy the user, for ourselves and noted goals and to-dos that we wanted to achieve and fulfill.
This resulted in first concept drafts of how an app might look. Though all our designs differed widely in style and execution, they all had they same user flow, leading from an onboarding process, guided by the therapist, to a task or excercise to react to certain situations, i.e. crisis. Yet it was still unclear to us what key-features the app would revolve around.
Still, in a meeting with a psychologist we got feedback on those first drafts after filling him in on our process thus far and what we had learned from the interview with the patient. He reminded us that one case of depression is not like the other and urged us to think less about treating individual cases and more about helping a larger number of people. Even though not all cases are alike, there are a few common denominators, such as overextension.
Furthermore he emphasized the necessity of an emotional log or diary, to keep track of the patients emotions. This sort of diary is sometimes part of therapy already, yet still happens on paper. Motivation on the other hand should best happen by giving positive feedback and creating a sense of achievement.
Revising our designs we unilaterally came up with a new draft divided into emotional log, tasks and excercises in order to motivate, and a statistics page for reflection in therapy.
The key-feature of the App was now the emotion wheel.
In our first user testing we showed our prototype to the patient, asking for feedback. The key-feature was definetly well received and easy to use. It was criticised though that there was no breathing space in the app. All you could do was tasks, which the patient didn't want to do streight after the emotional log entry. The patient suggested breathing space between the diary and the tasks, space to browse through pictures and articles to relax the mind.
During the annual student exhibition "Werkschau" at the FH Potsdam we took the chance to display our prototype again, this time supported by a poster explaining the concept. We showed the app to visitors of the exhibition and collected more feedback as a few questions were raised about privacy and transparency with an app like this.
Over all the success of this project is mostly due to the lean open-mindedness of its contributors. It could not have evolved the way it did without a sense of right and wrong and knowing when stand up for an idea and when let go of your own beliefs in favor of the greater good. And in the end that is probably what this project for to us - at least that's what it felt like. This - if nothing else - is proof of the level of importance design has achieved.
Timeline –– Findings
- Design Sprint – Patients need support outside therapy
- Interview 1: Videocall w/ Patient – in an acute crisis a patient has little to no control
- Group Ideation – App must act in support of therapy and as emotional diary
- First Concept Drafts – Onbaording & Regaining Routine
- Interview: Meeting w/ Psychologist – Depression vary from patient to patient; positive feedback is important
- Second Concept Drafts & Prototyping – Emotion Wheel as Input & Excercises as follow up
- First User Test w/ Patient – „no breathing room between wheel and excercises“
- Poster & Prototype on display @ Werkschau FHP – Need for Emergency Button
- Second Interactive Prototype Iteration – to be continued
Goals & Constraints
At the beginning of the project, because of the delicacy of the subject matter, we created a set of boundaries, rules to live by while going about creating the solution for the problem at hand.
It was important to always take into account the user‘s privacy and also his potentially vulnerable mental state. We set help the user with individual tasks and excercises. But we couldn‘t make them individual without user data.
Depression is the most common mental illness and affects those suffering from it 24/7. However the treatment in form of therapy occurs maybe 2 hours a week. A common theme in depression is overextension, the feeling of being overwhelmed even by the simplest of things. So patients need help outside of therapy sessions.
Project NAAU aims to help the patient full-time and to support the therapeutic process through a combination of emotional reflexion,tasks and exercises to boost the patients self-esteem. This service however will not be able to replace therapy. The way depression is treated today is to search for its roots, to see where it came from. So this type of mental illness is deeply embedded in the patient's personal life. Therefore in depression there is no such thing as average, every case is different from the other.
What NAAU tries to do is help the therapist gain a deeper understanding of his patient while helping the patient tackle everyday life.
To understand why we try to capture emotion using our wheel, one first needs to know that we hadn‘t originally intended for it to play such a vital role within the app. We thought it was in violation of one of our early set constraints, which read that the app should never seem to annoy the user actively. But it was through several interviews with a patient and a psychologist that we learned the importance of this essential function. Though both psychologist and patient stated that any kind of emotional diary can be tiresome at, the major upsides were that the patient actually has a routine thing to do, day in, day out, and the result, meaning the insights one can gain from such a diary can prove to be helpful in the process of therapy. In conclusion we reconsidered and thereon emotional documentary was a must-do.
We agreed that the method must be kept rather simple, the user shouldn‘t have to go to too much trouble to document how he/she is feeling. In order for there be any insights in the emotional diary there needed to be a contextual component, something to tell, from where and when and under which circumstances the emotion was felt. That way the therapist would be able to tell a pattern from the diary and gain insights into the patients mental state beyond therapy.
Next we needed to distinguish the right measure of emotion. We started out with a simple scale ranging from negative to positive, the interaction happened through a slider. This we noticed was a rather dull experience, that completely lacked any form reflexion upon the feeling you were documenting. Reflexion is important to verify the emotion. Is this what I am feeling? With internal reflexion the user verifies, if not to anyone else, at least to himself that yes, I am feeling this emotion. Without that reflexion process the user might not even recognise his own emotion when looking at the stats only a few days later. This would cause inconsistency throughout the data and result in distrust from the user.Therefore component A needed some form of feedback. But defining emotion is very difficult and almost entirely subjective. So we thought it best to keep our feedback abstract. The Result was Günther (the cartoony face/slider).
As we made first scribbles of the informational architecture of the app and how certain functions are linked, we decided that our current emotional diary system was, on one hand, a bit too quirky to deal with user‘s in various mental states and on the other hand too one-dimensional, as the other main feature of the app relied heavily on the input given in this step. So we simply added a new dimension.
The new dimension opened up whole new class of design options, but it also required a new system of emotions are interlinked with each other. If we wanted to show emotion in a dial metric , we would have to do the research.Initially we went with Plutschik‘s wheel of emotions, which has 4 axis‘ expressing 8 different types of emotion. The problem was however that the words did not always communicate the meaning of the emotion in the context of the wheel. This sparked a discussion about wether to mix different emotional wheel schemes (such as Scherer‘s) or to stick to one system and use misleading words to describe emotion.First we went with a mixture, since we figured there are only four names for emotions visible on the wheel, so the bar for systematic conformity was fairly low. Then the feedback changed and there are now words shown for every emotion, wherever the user would drag the button to. So there was now a need for systematic conformity. We decided to go with Scherer‘s because it has a wide range of connected emotions.
We concluded that on-boarding with the therapist ensures a smooth acclimatisation for the patient and builds up the trust towards this system. The therapist also guarantees a save use by the patient because he/she is not left alone analysing all the outcomes of the app.
We therefor focussed in our first mock-up's on this subject, all team members individually and then we met up with a psychologist to find out which ideas might work.
After weeks of talking to our first user only over Skype, we finally were able to meet up with her and present our first interactive prototype.
We took our time to look together into all the details of our app and were able to find a lot of weak points in our interface. But in conclusion, the overall system and moodwheel were accepted and the patient enjoyed using it.
It is only the The first page, the mood wheel, since another company does not allow us to upload the prototype we made with their software.
Conclusion & Future
While we are writing this, NAAU as a project, as an idea, is waiting to be finished. Several people and organisations already showed interest in validating this concept. We found out that we seem to work together pretty well as a team, which might be because we all have slightly different approaches to design. Interdisciplinary light, which fits the mindset of Lean UX.
This course was the first time we got in contact with the lean-mindset and we enjoyed the amount of freedom and trust Marian put into us. He gave us a good theoretical base, the book: “Lean UX” also helped and made us love the process. Though, If we had never done Design Sprints before, and weren’t been highly motivated and keen on learning about depression as a sickness, we probably wouldn’t have been as successful.
Struggle and chaos were definitely part of the process, but constant reevaluating and feedback on all levels helped structuring it just right towards the finish line to have tested, iterated, “lean” prototypes.
Please contact us if you want to collaborate with us on a scaleable proof of concept.