A predictive health app & wearable

Novi app and smart watch mockups.

A predictive health app & wearable

Novi app and smart watch mockups.
Overview
Diagnosis and treatment errors of confusing pregnancy-related hypertensive disorders cause the injuries and deaths of hundreds of thousands of pregnant people and babies every year.
Our research indicated that pregnant people need their health data to be more current, accessible and understandable in order to better advocate for their treatment.
We designed an app and wearable for pregnant people and their medical providers to predict, monitor and manage their health via data production, organization, machine learning and communication in order to improve experiences and outcomes.
Scope
Role
Constraints
Tools
UX design collaboration
with Ashley Des Marais
Figma
Maze
80 hour school project over four weeks in May/June 2020
Google app & wearable for Android
100% remote
RESEARCH

Learning about hypertensive diseases of pregnancy

Then we saw the data come to life as we heard six women retell their experiences (which ranged from a few months to 14 years prior) via semi-structured, one-on-one interviews.
We used a few secondary research methods to answer our questions about preeclampsia and HELLP Syndrome, their effects on people and systems, and what other competitive or comparative products are currently available.
Deliverables
Literature Review
Market Research
Competitive Analysis
Interviews

Literature Review

Although there are common risk factors, preeclampsia and HELLP Syndrome can develop suddenly, even in healthy, young people.
These hypertensive disorders present with high blood pressure and various liver and blood abnormalities, but are diagnosed by specific combinations of symptoms that are so complex, many cases are not recognized or treated appropriately.
The diseases are complicated
Preeclampsia and HELLP syndrome infographic.
A "chicken-or-the-egg" situation
Inaccurate record-keeping in combination with the rarity of the diseases has made it difficult to improve datasets for early warning systems that providers rely on for life-saving interventions. And when research lags, training lags even more.
Researchers rely heavily on hospital records to conduct their studies, but many cases slip through the cracks when symptoms don't cause death, go unrecognized, or develop weeks after giving birth. Some hospitals also misrepresent or hide their data in order to avoid scrutiny and discipline.
An estimated 60% of deaths from preeclampsia are preventable, due to errors in diagnosis and treatment
California alone lowered their death rate by 50% by implementing new practices while deaths rose across the country
We looked into how the United States is navigating these issues and were surprised to see limited and scattered efforts:
Out of all developed nations, the U.S. ranks 65th in maternal mortality
There are no federally-enforced treatment standards and a law mandating state maternal death reports wasn't passed until 2018

Not surprisingly, decades of slow progress in research, training and regulation play out on a global scale, with approximately 75,000 adults and 500,000 babies around the world dying every year from pre-eclampsia and HELLP Syndrome.

Novi walk-through mockup that says: "Necessary: We know that the early detection of Preeclampsia and HELLP Syndrome saves women's and babies' lives."

Market Research and Competitive Analysis

The costs associated with pregnancy-related hypertensive diseases are significant:

The U.S. healthcare system spends $2.45 billion on affected adults and babies the first 12 months after birth

Even with insurance, pregnant people can spend up to $5,500 out-of-pocket for their emergency c-section
Suffering injuries or losing loved ones is an unfathomable price for a family, on top of rehabilitation, income loss, funeral expenses and more.
In 2018, a hospital settled a wrongful death case for $12 million after ignoring its own high-risk treatment policies
Pregnancy diseases are expensive and overlooked
Novi competitive analysis comparing a Purdue University app, Badgernet Maternity Notes, Preeclampsia Disease app, Omron Heart Advisor Blood Pressure app, and Baby Center Pregnancy Tracker and Countdown app.
In 2019 there were over a billion cisgendered women with smart phones or tablets that could use a health app, but even with 250+ Android pregnancy apps, we were only able to locate:
one primitive app (Android only) dedicated to preeclampsia information
one app in development (Purdue) that connects to equipment and provides predictive tracking‍
one app (UK only) that connects to equipment, tracks and integrates data with in-person appointments
I knew about pre-eclampsia...I didn't know about HELLP Syndrome, though, not even when I got it. I found out about it when I got transferred by ambulance to a higher-level hospital.
Novi Interviews
Pregnant people are vulnerable

Interviews

Partial image of a document with typed interview questions.
Because we were curious about the information, tools and care pregnant people are typically provided during and after pregnancy, especially as concerning symptoms develop, we asked our cohort to get really specific while sharing their stories.
Their experiences corroborated our secondary research findings around:
The real or perceived lack of information given to pregnant people about their disease
Inadequate followup appointments and education on lifelong effects for people and their babies
Most people's initial ignorance about pregnancy-related hypertensive diseases
Disbelief, misdiagnosis and mistreatment of symptoms from medical providers when concerns were raised
The real or perceived lack of information given to pregnant people about their disease
Inadequate followup appointments and education on lifelong effects for people and their babies
Most people's initial ignorance about pregnancy-related hypertensive diseases
Disbelief, misdiagnosis and mistreatment of symptoms from medical providers when concerns were raised
When questioned how it felt to navigate their new disease, some themes emerged as our interviewees relayed:
Confusion from missing or conflicting information from doctors
Frustration over lack of trust and communication
Fear and sadness about their loss of control and unknown future
I'm glad to report that everyone we spoke with had a successful outcome, thanks to self-advocacy, intervening midwives, switching hospitals or access to competent providers from the outset.
Hey, if something feels off, you need to just trust your body and your gut and pursue it. It’s not worth the risk to you when a doctor brushes you off. It’s your life, and people die of this.
Novi Interviews
SYNTHESIS

Searching for an overlap of needs

We looked for trends in our research that pointed to the underlying needs of pregnant people and how they interact with the needs of medical providers, hospitals, researchers and governments.
Deliverables
Affinity Map
Personas
Venn Diagram of Needs
User Journeys
A partial image of an interview affinity diagram with sections of post-it notes organized by group.

Affinity Map

Placing needs in context
We used Erika Hall's Just Enough Research grouping guidelines to organize our interview stories, recognize commonalities across experiences and discover missed opportunities. One example of an overlooked need was the effect that environment had on our interviewees' mental and physical health:

Home
Difficulty remembering what their doctors explained
Anxiously waiting for appointments and calls about lab results to know what's happening in their bodies
Difficulty in understanding the implications of decisions and knowing what questions to ask
Blood pressure artificially high from stress and fearful anticipation
Difficulty advocating with a provider that disregards their health history and/or cultural norms
Hospital
Difficulty self-assessing and reporting symptoms (especially first-time pregnancies)
By comparing the constraints of home and hospital, we saw they both drew attention to a lack of understanding and control around symptoms and test results.
Without timely access to understandable, actionable information about their health status, our interviewees were left in the dark and quite vulnerable.
Another significant stressor that came up was loss of control, as some struggled to be heard and believed by an untrained provider.
Placing context within a system

Personas

A Novi persona: "Jacqueline" who is a black married professional in Los Angeles.
This is especially true for Black cisgendered women, who are three to four times more likely to die from pregnancy or childbirth than white cisgendered women, not from physical reasons, but from the implicit bias of their doctors.
These injustices remain ubiquitous when governments don't require accountability from all medical providers in examining practices, improving training and reporting outcomes truthfully.
We melded the contexts, thoughts, feelings and behaviors discovered in our research into personas to guide our design decisions.
Accurate measurement of maternal mortality is an essential first step in any prevention program: to identify at risk populations, to target prevention efforts to the most vulnerable groups, and to measure the progress of prevention programs.
Overview of US Maternal Mortality Policy, 2020

Venn Diagram of Needs

Like the diseases themselves, there are many variables in this problem. But when analyzing the relationships between participating groups*, we saw a pattern of transactions involving information and a form of support.

The most critical need is the most lacking

Pregnant people need protection from governments and information and treatment from healthcare providers to stay alive and uninjured.

Governments need information from researchers and hospitals to protect pregnant people and save lives and money.

Researchers need information from hospitals and pregnant people to recommend better treatments.

Hospitals need information from researchers and pregnant people to improve treatments and save lives and money.

An animated venn diagram outlining needs between pregnant people, governments, healthcare workers and hospitals, and researchers.
Simply put, each party needs an increase in the quantity and quality of information they're receiving to better accomplish their goals.
*Private insurance companies are not represented in this diagram (despite financially benefitting from improved health outcomes), as its purpose is to reveal interdependence and shared needs and goals.
A novi walk-through mockup that says: "Innovative: Our smartwatch blood pressure cuff puts information and control where it belongs: in your hands."

A catalyst for change

Systemic issues won't be immediately or solely solved with an app. But it's possible that as pregnant people offset their vulnerability with education and advocacy, their empowerment could simultaneously improve maternal health research, training and regulations.

With that aim, our app will serve to:
Increase data for researchers
Centralize and demystify information for pregnant people
Produce and synthesize additional data to drive predictions for healthcare providers
Provide specialized support for pregnant people and healthcare providers
Improve accountability for governments
Society will be like, ‘Well, you’re not a doctor, so leave it to the experts, you don’t know.’ That’s not true--people need to feel empowered to learn and advocate for themselves.
Novi Interviews
IDEATION

Creating tech solutions for human problems

Because we needed the app to be cohesive with other Google products, we analyzed the information architecture of several Google apps and some well-known health-tracking apps.

Next, we brainstormed potential features, prioritized them and organized the app's structure. Then we designed screens, obsessed over data visualization and connected it all up in a mid-fi prototype to test for usability.
Deliverables
Feature Roadmap
Sitemap
User Task Flows
Mid-Fi Wireframes
Mid-Fi Prototype

Design Principles

A novi walk-through mockup that says: "Data-driven: Track, predict and manage your pregnancy and postpartum symptoms at home or on the go."

While we played a bit with branding, our brief was to design a Google app which meant coherence with the company's UX guidelines, so we outlined our design principles in a similarly purposeful, no-frills fashion:

We wanted the app's clean appearance and streamlined flow to exude the kind of professional bedside manner anyone would feel confident putting their trust in.

No endless scrolling

Show the most important information first

Easy access to activities

Tabbed and nested content

Conveying a steady calm

Feature Roadmap

Matching broad goals with specific features
A partial image of a feature roadmap spreadsheet listing features, descriptions, research supporting, and priority level.

Our feature roadmap and sitemap helped us identify and organize all the features we hoped to include in the app, but our project timeline forced us to prioritize the most crucial to demonstrate the concept.

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

Sitemap

Most of our early decisions revolved around organizing the user's activities and data and how to display it.

This required a lot of iterating to continually clarify why/what/where/how/by whom features would be used in various task flows. It wasn't always obvious.

A small spreadsheet differentiating types of features by ownership, purpose and location.

For example, we wondered if there was redundancy in our reminders, to-dos and notifications. We began to combine them but then realized their purpose and ownership were different enough to potentially confuse the user, so we got nitty-gritty with our definitions.

Navigation

A mockup gif of tapping the nav bar and visiting the Home, Health and Tools sections.

With our guidelines reminding us keep our app's goals at the forefront, we divided our content into three main sections:

A Home page (health overviews and reminders) that keeps the user active and organized

A Health section (data collection and synthesis) that keeps the user educated

A Tools section (action plans and communications) that keeps the user prepared and supported

Encouraging use
A mockup gif of Novi's floating action button being pressed.

Floating action button

Encouraging data production

We observed the usefulness of floating action buttons (FABs) in several data-tracking apps, and implemented a couple of our own.

They serve the user as both a consistent reminder and a convenient avenue in accomplishing tasks.

The FAB located in the Home and Health sections contains quick access to blood pressure testing, logging symptoms, setting reminders and adding appointments and other test results.

The categories are arranged by priority, with the user's current stage of their action plan taking precedence, and the other categories serving as an overview of their activities and health status.

Encouraging organization
A mockup gif exploring the home page.

Home

The Home page is organized by horizontally scrolling action cards, with button categories on top, and their corresponding action cards beneath.

Because everyone has different preferences with their task organizers, we wanted the user have a fair amount of editing power so that reminders and data displays fit their personality and lifestyle, making them more likely to use them consistently.

The Health section makes it easy for the user to observe the many often unseen and unfelt changes in their bodies over time. The tests, symptom log and calendar activity overview are meant to put the pieces together with holistically-informed understanding and continually guide them toward their action plan.

We struck a balance and promoted clarity and accessibility with copy, color, icons, shapes, patterns, tabs and toggles.

Health section

A mockup gif exploring the Health section.
Encouraging education

We found our biggest challenge of the project in the form of data visualization. With so many types and timespans to represent inside limited space, the risks were to be visually overwhelming and hard to read, or so broken down that they weren't understandable as a whole.

Smart watch

And now for the highlight of this project: the blood pressure cuff smart watch! This is how Novi meets the user's need for more control over their health information. By allowing blood pressure readings anytime and anywhere, the larger sample of results can be averaged and contextualized for better accuracy.

While test results can be viewed on the watch, the much smaller screen size required paring down most content and providing links to see more in the phone app.

We still placed a priority on activities and information that funnel the user toward their action plan and support system, like reminders that let them request an appointment right from their wrist.

Encouraging blood pressure testing
A mockup gif of taking a blood pressure test on the smart watch.A mockup gif of setting an appointment with the smart watch.A mockup gif of swiping across the watch screen to access sliding drawers of action buttons.

The FABs were translated into sliding drawers, accessible at any time with a swipe to the right or left.

Tools section

A novi walk-through mockup that says: "Personal: Some concerns can't hold. With Novi+ our Perinatologists advise and advocate for you, day and night."

The Tools section helps alleviate confusion and anxiety by reminding the user that they have a plan and they have support.

The action plan, determined by AI and validated by specialists, explains why the user is placed in their current plan and suggests helpful actions to manage the progression of disease.

The other tabs include an email-like messaging system and a medical notes file. If the user integrates their primary healthcare app, they'll be able to keep all their communication in one place, and if not, they can still involve other team members via messaging and sharing.

Encouraging preparation and communication

We intended for the FAB in the Tools section to be different and reflect its particular purpose, so the buttons here allow for sending messages, speaking with the on-call specialist or requesting an appointment.

This way the user is able to quickly communicate whenever they feel the need, no matter how deep into the section they are.

A mockup gif of tapping the FAB in the Tools section.A mockup gif of exploring the Tools section.
RESULTS

Putting the product to the test

A sample of five women tested our mid-fi designs remotely via Maze.com while we moderated over Zoom. We asked them to try out a few tasks in the app and then made changes to improve usability.
Deliverables
User Testing Findings
UI Kit
Hi-Fi Prototype

Testing and iterating

A partial image of a Usability Test Findings document.

All of our test 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 were expecting their first child.

Narrowing paths and clarifying nomenclature

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.

Error-free Rate

Completion Rate

Task 1: 100%

Participant 1: 66.6%

Participant 2: 33.3%

Participant 3: 33.3%

Participant 4: 66.6%

Participant 5: 33.3%

Task 2: 100%

Task 3: 80%

It turned out that participants thought they'd find contact details or app troubleshooting in the "My Help" section, not their action plan.

100% of users struggled to find their action plan.

Insight

Problem

Potential Solution

We relabeled "My Help" as "Tools" to clarify that section's contents.

Most misclicks were due to limitations with the mid-fi prototype or test method, but a few design problems stood out either from consistency or importance:

Insight

Problem

Potential Solution

The copy "Average Blood Pressure" indicated to a user that their blood pressure results were average, when the results listed were actually high.

We rewrote "Average Blood Pressure" as "Your average blood pressure is ___" to avoid confusion.

A participant misunderstood the blood pressure results.

Insight

Problem

Potential Solution

The participant thought the first card might be linked to more stats because the lower one appeared to be a CTA.

We placed blood pressure information copy directly on the screen and made the "Recommendations" card a CTA button for more clarity.

A participant clicked on the Blood Pressure Stats cards instead of using the tabs.

Insight

Problem

Potential Solution

It may have been due to feeling pressure to move quickly, but it also could've been instinct to use a search tool.

Some participants headed to the hamburger menu to find things instead of exploring via nav bar.

More testing might show a need for a search feature, but first we dumped the hamburger menu content into the avatar pop-out menu to guide the user toward the main sections.

A gif of a user testing session.

This participant initially clicked on "My Health" to find her action plan before finding it in the "My Help" section.

As soon as this participant realized the menu was non-functional, she used the nav bar.

This participant was drawn toward using the cards instead of the tabs.

A gif of a user testing session.A gif of a user testing session.View more test findings

The final prototype

If you'd like to explore the final prototype, click here.

Where to go from here

Novi walk-through mockup that says "Novi: be informed, be empowered, be at ease."A illustration of a mother sitting and holding her baby.

I got really attached to this project and would love to see this app become a reality, so there's a lot more I want to design and test:







Completion To-Dos

Create flows and screens around symptom logging (including notes about completed action plan items) and adding external test data (including the onboarding flow integrating other health-related apps).

Create a desktop site for the specialist's side and for users to see their data on a larger screen.

A/B testing with health (including data production effects on early warning systems, action plan effects on morbidity/mortality outcomes, and if on-call specialists improved understanding, confidence and self-advocacy for app users) and financial outcomes (including savings on in-person appointments and emergency interventions).

Future versions might include features for gestational diabetes and other pregnancy-related diseases.

Testing To-Dos

Future To-Dos

Where to go from here

Novi walk-through mockup that says "Novi: be informed, be empowered, be at ease."A illustration of a mother sitting and holding her baby.

Completion To-Dos

Create flows and screens around symptom logging (including notes about completed action plan items) and adding external test data (including the onboarding flow integrating other health-related apps).

Create a desktop site for the specialist's side and for users to see their data on a larger screen.

I got really attached to this project and would love to see this app become a reality, so there's a lot more I want to design and test:







A/B testing with health (including data production effects on early warning systems, action plan effects on morbidity/mortality outcomes, and if on-call specialists improved understanding, confidence and self-advocacy for app users) and financial outcomes (including savings on in-person appointments and emergency interventions).

Future versions might include features for gestational diabetes and other pregnancy-related diseases.

Testing To-Dos

Future To-Dos

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