End to end application and wearable design

Google Novi

TLDR; hop to prototype

Google Novi

Improving maternal and prenatal health outcomes with data-driven predictions

End to end application and wearable design

Improving maternal health outcomes with data-driven predictions

Overview
Many women and babies experience severe injuries or die from Preeclampsia/HELLP Syndrome due to lack of information and medical regulations.
Our team designed an app and wearable combo that allows women to predict, monitor and manage their preeclampsia/HELLP disease.
Role
I collaborated on this project with another student; all research and design decisions were a joint effort, however, for this case study I will only show my individual work with the exception of the prototype.
TLDR; hop to prototype
Challenge
Design a Google Android app that helps users predict, monitor and manage their preeclampsia/HELLP disease
Solution
An app and wearable combo that allows for data production, organization, communication and machine learning
(For prototype, switch to desktop)
(For prototype, switch to desktop)

Project background

Preeclampsia and HELLP Syndrome are complicated diseases unique to human pregnancy and characterized by an incredibly quick and dramatic onset.

Preeclampsia is diagnosed by the elevation of the expectant mother's high blood pressure, usually after the 20th week of pregnancy. Preeclampsia and related hypertensive disorders of pregnancy impact 5-8% of all births in the United States, with the rate increasing by 25% in the last two decades. It is a leading cause of maternal and infant illness and death.

HELPP is a syndrome found in pregnant and postpartum women characterized by the disruption of red blood cells, elevated liver enzymes and a low platelet count. HELLP is considered by some to be a severe form of preeclampsia but the relationship between the two disorders is controversial. HELLP Syndrome reports maternal mortality ranges from 1%-3%, with a perinatal mortality rate of 35%.

We hoped to create an app that will help ease some of the frustrations and fears that women experience during pregnancy, especially in regards to preeclampsia and HELLP diagnoses.
Note: I collaborated on this project with another student; all research and design decisions were a joint effort, however, for this case study I will only show my individual work with the exception of the prototype.

Before we begin

Here are some assumptions we had going into this project:

Women know little to nothing about preeclampsia/HELLP syndrome until they develop it
Women are dependent on medical providers to give them information and make decisions about their disease
Medical providers often mismanage maternal hypertensive diseases due to lack of information
Companies use livestreams to expand their user engagement and make money

Before we begin

Here are some assumptions we had going into this project:

Women know little to nothing about preeclampsia/HELLP syndrome until they develop it
Women are dependent on medical providers to give them information and make decisions about their disease
Medical providers often mismanage maternal hypertensive diseases due to lack of information
Companies use livestreams to expand their user engagement and make money

Our research goal was to learn what problems women face before, during and after a Pre-E/HELLP Syndrome diagnosis in order to determine possible features for the application.

Behind the curtain

Our research goal was to learn what problems women face before, during and after a Pre-E/HELLP Syndrome diagnosis in order to determine possible features for the application.

Out of all the developed countries, the United States ranks 65th in maternal mortality due to lack of standardized, enforced regulations. Each year over 50,000 American women are severely injured from giving birth, and 700 of them die. Other countries have used decades of research to improve practices, while the US has been slow to act: the Centers for Medicare and Medicaid Services do not require childbirth complication reports from hospitals and the Joint Commission, a private accreditation group that sets safety standards for thousands of hospitals, has had no reporting requirements for failure to follow maternal health guidelines. California alone implemented practices that reduced their maternal death rate by 50%, while deaths continued to rise across the country. Only last year did the Joint Commission introduce two new standards set by AIM (The Alliance for Innovation on Maternal Health), to go into effect July 2020, addressing complications in the areas of maternal hemorrhage and severe hypertension / preeclampsia.

The American Journal of Obstetrics & Gynecology issued a report last year estimating the costs to the U.S. healthcare system for preeclampsia at $2.18 billion for the first 12 months after birth — $1.03 billion for mothers, and $1.15 billion for babies.

What help is there?

With education, standards and practices varying from hospital to hospital, it's abundantly clear that the healthcare system has failed women, but how can they help themselves?

A majority of the 3,000 digital women's health solutions available offer fertility, prenatal and/or postpartum services dedicated to data, coaching and promotion, while other areas are niche markets. Shockingly, we were only able to locate one primitive app dedicated to preeclampsia information, and news of approximately two apps in development that provided predictive or wearable-based tracking. This leaves a lot of room for growth when it comes to life-saving, preventative digital services, and women deserve better than this.

Spotify's livestream competitors

Behind the curtain

Out of all the developed countries, the United States ranks 65th in maternal mortality due to lack of standardized, enforced regulations. Each year over 50,000 American women are severely injured from giving birth, and 700 of them die.

Other countries have used decades of research to improve practices, while the US has been slow to act: the Centers for Medicare and Medicaid Services do not require childbirth complication reports from hospitals and the Joint Commission, a private accreditation group that sets safety standards for thousands of hospitals, has had no reporting requirements for failure to follow maternal health guidelines.

California alone implemented practices that reduced their maternal death rate by 50%, while deaths continued to rise across the country. Only last year did the Joint Commission introduce two new standards set by AIM (The Alliance for Innovation on Maternal Health), to go into effect July 2020, addressing complications in the areas of maternal hemorrhage and severe hypertension / preeclampsia.

The American Journal of Obstetrics & Gynecology issued a report last year estimating the costs to the U.S. healthcare system for preeclampsia at $2.18 billion for the first 12 months after birth — $1.03 billion for mothers, and $1.15 billion for babies.

What help is there?

With education, standards and practices varying from hospital to hospital, it's abundantly clear that the healthcare system has failed women, but how can they help themselves?

A majority of the 3,000 digital women's health solutions available offer fertility, prenatal and/or postpartum services dedicated to data, coaching and promotion, while other areas are niche markets.

Shockingly, we were only able to locate one primitive app dedicated to preeclampsia information, and news of approximately two apps in development that provided predictive or wearable-based tracking.

This leaves a lot of room for growth when it comes to life-saving, preventative digital services, and women deserve better than this.

Novi's competitors

You don't know what you don't know

We interviewed six women with one or more experiences with preeclampsia and/or HELLP Syndrome.

The stories we heard were woven through with themes of lack of trust, communication and information from healthcare providers, needlessly compounding the pain, fear, confusion, and helplessness they experienced as additional trauma.

The quantity and quality of information available about these conditions is confusing and seemingly unstandardized.

Loss of control led to significant feelings of helplessness, fear, confusion, frustration and sadness.

They experienced negative consequences from lack of communication between providers and a startling lack of agreement on symptom significance and procedures.

Advocacy and trust between providers and patients was a running theme, as sometimes women felt their preferences and concerns were brushed off.

Most could not recall being informed that pre-e/HELLP could have life-long health implications or being put on a plan for monitoring beyond six weeks postpartum.

Participants who went on to have more pregnancies reported becoming better advocates for the kind of care they wanted for themselves and their babies.

Using Erika Hall's grouping guidelines to categorize our interview findings, we discovered the highest ranking subgroups on which to focus our app features:

Goals: preparation and a safe and healthy pregnancy

Priorities: the newborn's and the mother's health

Tasks: advocacy, education and taking proactive health measures

Motivators: loss of control, physical symptoms and relationship with healthcare providers

Barriers: relationship with healthcare and loss of control

Habits: healthcare appointments

Relationships: healthcare, family, and friends and community

Tools: drugs, medical equipment and tests, and websites and apps

Environments: medical and home

Feelings: overwhelm and fear

Quotes: advocacy

View interview resultsView research debrief

You don't know what you don't know

We interviewed six women with one or more experiences with preeclampsia and/or HELLP Syndrome.

The stories we heard were woven through with themes of lack of trust, communication and information from healthcare providers, needlessly compounding the pain, fear, confusion, and helplessness they experienced as additional trauma.

The quantity and quality of information available about these conditions is confusing and seemingly unstandardized.

Loss of control led to significant feelings of helplessness, fear, confusion, frustration and sadness.

They experienced negative consequences from lack of communication between providers and a startling lack of agreement on symptom significance and procedures.

Advocacy and trust between providers and patients was a running theme, as sometimes women felt their preferences and concerns were brushed off.

Most could not recall being informed that pre-e/HELLP could have life-long health implications or being put on a plan for monitoring beyond six weeks postpartum.

Participants who went on to have more pregnancies reported becoming better advocates for the kind of care they wanted for themselves and their babies.

Using Erika Hall's grouping guidelines to categorize our interview findings, we discovered the highest ranking subgroups on which to focus our app features:

Goals: preparation and a safe and healthy pregnancy

Priorities: the newborn's and the mother's health

Tasks: advocacy, education and taking proactive health measures

Motivators: loss of control, physical symptoms and relationship with healthcare providers

Barriers: relationship with healthcare and loss of control

Habits: healthcare appointments

Relationships: healthcare, family, and friends and community

Tools: drugs, medical equipment and tests, and websites and apps

Environments: medical and home

Feelings: overwhelm and fear

Quotes: advocacy

View interview resultsView research debrief

Meet Jacqueline

We categorized our interview participants by behaviors and personality types and split them into two personas that could represent their perspectives.

Meet Jacqueline

We categorized our interview participants by behaviors and personality types and split them into two personas that could represent their perspectives.

The nitty gritty

We knew that Google Novi would be for women navigating:

Pre-existing high-risk indicators such as age, BMI, and hypertension

• A prior (or genetic) history of pregnancy health issues

Less access to quality healthcare

• A pre-e and/or HELLP Syndrome diagnosis

• The natural concerns and need for peace of mind between pre- and postnatal appointments

Our higher level goal was to provide "control for women via information and accessibility, in order to feel calm, equipped, prepared, and at ease."

Our objectives to get us there:

Pair app with a blood pressure cuff smartwatch so women can check their health status at any time
Allow tracking of symptoms and other tests so women can see their trends over time
Use data to drive predictions so women can take preventative measures and receive timely interventions
Provide on-call Perinatal specialists so women have qualified resources and advocates

The nitty gritty

We knew that Google Novi would be for women navigating:

Pre-existing high-risk indicators such as age, BMI, and hypertension

• A prior (or genetic) history of pregnancy health issues

Less access to quality healthcare

• A pre-e and/or HELLP Syndrome diagnosis

• The natural concerns and need for peace of mind between pre- and postnatal appointments

Our higher level goal was to provide "control for women via information and accessibility, in order to feel calm, equipped, prepared, and at ease."


Our objectives to get us there:

Pair app with a blood pressure cuff smartwatch so women can check their health status at any time
Allow tracking of symptoms and other tests so women can see their trends over time
Use data to drive predictions so women can take preventative measures and receive timely interventions
Provide on-call Perinatal specialists so women have qualified resources and advocates

Let's get to it

With so many areas to cover, we needed to identify and organize our application's features and structure with a feature roadmap, sitemap and user flow.

Click or tap to view larger image

Let's get to it

With so many areas to cover, we needed to identify and organize our application's features and structure with a feature roadmap, sitemap and user flow.

View sitemapView user flow

Simplicity and clarity

Some of our early decisions revolved around organizing the user's data and how to display it without being overwhelming or difficult to find. We divided content into three areas: a Home page for health snapshots and reminders, a Health section for data collection and synthesis, and a Tools section for the action plan and communications with medical providers.

The Home page is organized by horizontally scrolling action cards, with button categories on top, and their corresponding action cards with CTAs beneath. The categories are arranged by priority, with the current stage of the user's action plan as number one.

Encouraging data gathering

The overarching aim for this app is to help prevent injuries and death resulting from pregnancy-related hypertensive disorders, so we knew we needed to encourage the user to enter a lot of data over an extended time period to ensure the accuracy of predictions. One way of accomplishing this was to incorporate a nearly global floating action button (FAB) to reduce the number of steps needed to add data and be a consistent reminder to do so.

Encouraging communication

A major draw for women to choose Novi as part of their prenatal care is the addition of the on-call specialists to their team, so the area dedicated to their personalized plan and communication with medical staff (Tools) has its own FAB.

A time to test

The wearable's main purpose is to take the user's blood pressure and send the data to the app, but we were uncertain of how much information could or should be displayed on its smaller screen size. We ended up keeping the home screen dedicated to reminders and snapshots, with a tappable option to display more data in the mobile app. Instead of FABs, there are action drawers to serve the same purpose of quick access to prioritized activities.

Charting new territory

While the Health section was my partner's domain, we collaborated on the data visualization and learned how difficult that is, especially when it comes to complicated health information. With limited space and many data types and timespans to break down, we went through numerous iterations, trying to promote clarity and accessibility with copy, color, shapes, patterns and toggles.

The goal was always to make it easy for our user to quickly understand what was happening with their health and to visually observe the typically unseen (and often unfelt!) changes that indicate a need for intervention. Some test participants noted the presence of graphs with excitement, reminding me of how much pregnant women like to nerd out on their data, so I think we're on the right track.

View UI Kit

Usability and revisions

A sample of five women tested our mid-fi designs remotely via Maze while we moderated over Zoom.

View test findings

Simplicity and clarity

Some of our early decisions revolved around organizing the user's data and how to display it without being overwhelming or difficult to find. We divided content into three areas: a Home page for health snapshots and reminders, a Health section for data collection and synthesis, and a Tools section for the action plan and communications with medical providers.

The Home page is organized by horizontally scrolling action cards, with button categories on top, and their corresponding action cards with CTAs beneath. The categories are arranged by priority, with the current stage of the user's action plan as number one.

Encouraging data gathering

The overarching aim for this app is to help prevent injuries and death resulting from pregnancy-related hypertensive disorders, so we knew we needed to encourage the user to enter a lot of data over an extended time period to ensure the accuracy of predictions.

One way of accomplishing this was to incorporate a nearly global floating action button (FAB) to reduce the number of steps needed to add data and be a consistent reminder to do so.

A major draw for women to choose Novi as part of their prenatal care is the addition of the on-call specialists to their team, so the area dedicated to their personalized plan and communication with medical staff (Tools) has its own FAB.

A time to test

The wearable's main purpose is to take the user's blood pressure and send the data to the app, but we were uncertain of how much information could or should be displayed on its smaller screen size.

We ended up keeping the home screen dedicated to reminders and snapshots, with a tappable option to display more data in the mobile app.

Instead of FABs, there are action drawers to serve the same purpose of quick access to prioritized activities.

Charting new territory

While the Health section was my partner's domain, we collaborated on the data visualization and learned how difficult that is, especially when it comes to complicated health information. With limited space and many data types and timespans to break down, we went through numerous iterations, trying to promote clarity and accessibility with copy, color, shapes, patterns and toggles.

The goal was always to make it easy for our user to quickly understand what was happening with their health and to visually observe the typically unseen (and often unfelt!) changes that indicate a need for intervention. Some test participants noted the presence of graphs with excitement, reminding me of how much pregnant women like to nerd out on their data, so I think we're on the right track.

View UI Kit

Usability and revisions

A sample of five women tested our mid-fi designs remotely via Maze while we moderated over Zoom. All participants were target users between 30-40 years of age; three with previous preeclampsia and/or HELLP syndrome diagnoses and two with no diagnoses that are expecting their first child. Participants were asked to complete a series of three tasks in the areas of onboarding, testing their blood pressure and accessing their data and action plan.

We discovered that category labeling was the main obstacle to completing the tasks, as participants had difficulty locating their action plans and showed preference for using a menu to search for them. We relabeled the "My Help" to "Tools" to help clarify what might lie in that section, and discarded the menu in favor of keeping the app simple. A Google application norm is to have the user's avatar in the upper right corner, so we placed any non-core features in that pop-out menu.

View test findings

The prototype

Start by clicking on the image and then head to the upper right corner to expand the page.

Next steps

Next would be creating flows and screens around symptom logging, especially for the smartwatch, and adding external test data, including integrations with the user's primary healthcare app.

While this was a capstone project for my UX design program, it means so much more than that to me as a HELLP survivor.

My mission is to see this app become a reality, to change the current maternal health narrative so that women and babies will no longer be the collateral damage of inept, sluggish systems, but instead can take charge of their outcomes through data, education and advocacy.

Next steps

Next would be creating flows and screens around symptom logging, especially for the smartwatch, and adding external test data, including integrations with the user's primary healthcare app.

While this was a capstone project for my UX design program, it means so much more than that to me as a HELLP survivor.

My mission is to see this app become a reality, to change the current maternal health narrative so that women and babies will no longer be the collateral damage of inept, sluggish systems, but instead can take charge of their outcomes through data, education and advocacy.

Another Case Study -->

Another case study -->

Want to work with me?

Want to work with me?