WeCare: Relieving Family Caregivers’ Stress through Improving Communication at theHospital
CHI Student Competition
A total of 5 undergrads from National Taiwan University
Secondary research: conducted literature review & competitor analysis
Observation: participated as a group
Interview: designed interview guidelines and conducted interviews
Usability testing: designed the tasks, drafted the observer guide, and led the study
Presentation: drafted the extended abstract for submission
Oct 2019- Jan, 2020
Who are family caregivers?
The rapid aging population is a worldwide phenomenon. However, Taiwan’s accelerating rate of aging is more than twice than that of European countries and the United State. With the population aging and more elderlies living longer, Taiwan is facing a larger demand of provision of informal care to older persons by family members. The majority of information care is provided by family caregivers, informal or unpaid caregivers who take care of their relatives.
Compared to non-caregivers, family caregivers report experiencing a higher level of stress. Caregivers' stress is particularly heightened when taking care of patients at hospitals since patients usually stay at hospitals when their conditions have worsened or changed.
Improve family caregivers’ caregiving experience at hospitals.
Observation: to understand the interactions between caregivers and patients
Interview: to delve deeper into caregivers’ motivations, challenges, and feelings
Usability testing: to validate if the designs meet users’ expectations
There were 703 million persons aged 65 years or over in the world in 2019. The number of older persons is projected to double to 1.5 billion in 2050.
Taiwan's high demand of caregivers:
Currently, Taiwan has 760,000 of people who require caregiving, and 50% of them rely on family caregivers.
Family caregivers' intense stress:
Family caregivers suffer from depression, report more physical and psychological symptoms, and exhibit a lower quality of life.
To have a better understanding of the natural interactions between caregivers and patients in the hospital, we observed 13 pairs of caregivers and patients at National Taiwan University Hospital and Wanfang Hospital.
During the observation, we focused on:
The interactions between the caregivers and the patients.
Whether there were other stakeholders nearby and what they were doing.
The facial expressions and body languages of each stakeholder.
The frequency of each pair’ interactions.
To learn about family caregivers’ caregiving experiences in the hospital, we interviewed 5 caregivers ages 45 - 60.
Has cared for a family member in the hospital within the past 3 months
Is the patient’s primary or secondary caregiver
Family caregivers have one major goal when caring for patients at the hospitals:
" I need to make sure that my family is being taken good care of at the hospital, including by myself, the rotating caregivers, and the medical personnel."
To achieve their major goal, family caregivers spend a lot of time and effort on every stakeholder's understanding of the patient's conditions. As such, we discovered that family caregivers’ major cause of stress at the hospital does not come from the act of caregiving itself, but communication and interaction with various stakeholders.
Communication with nurses - difficulty in memorizing caregiving information
Nurses give instructions in the morning that caregivers have to carry out throughout the day, such as measuring bowel movements, food quantity, and etc. However, they often worry about forgetting the specific instructions from nurses, which causes stress.
Communication with doctors - difficulty in accurately reporting patient’s condition
Doctors meet with caregivers regularly to make sure if the medication and treatment are appropriate and if any adjustments should be done. Caregivers think they could not report symptoms of the patients precisely and comprehensively due to forgetfulness, which makes them feel guilty.
Communication with rotating caregivers - difficulty in synchronizing information
When there are multiple caregivers rotating at the hospital, each caregiver may not be fully updated about the latest information. Therefore, caregivers are concerned that this miscommunication may affect the caring quality.
Rushed interactions with patients during mealtimes
Since the hospital cafeteria is busy and crowded during mealtimes, it’s difficult to help patients navigate around, and leaving the patient along while they order food makes caregivers feel nervous.
Journey map: a family caregiver's day in the hospital
How might we relieve caregivers’ stress at the hospital through improving communication with stakeholders?
To explore current solutions, we conudcted competitive analysis on apps that support caregivers or patients. However, the majority of products on the market focus on assisting patients in taking care of themselves outside of the hospital, which cannot fulfill family caregivers’ need of communicating more efficiently with multiple stakeholders at the hospital.
Aiming to help family caregivers overcome the 4 majors stressors they experience when interacting with stakeholders at the hospital, we designed WeCare.
WeCare is an application placed at a fixed position in hospital rooms since it’s designed to be used by many. In addition, since our targeted caregivers are often those who are also part of the aging population, we would utilize a tablet-sized screen that is more accessible for people with physical limitations (e.g. deteriorating eyesight) compared to a phone-sized screen.
MEMORIZE - ease caregivers' burden caused by memorizing nurses’ instructions
This feature enables nurses to set the tasks on WeCare based on each patient’s conditions (e.g. taking medicines, measuring food quantity). Therefore, caregivers don't need to worry about jotting down instructions since tasks that should be completed are always visible and they will be notified of each task.
REPORT - report patients' conditions more accurately
To help caregivers report patient's symptoms to doctors more acurately, “report” displays multiple symptoms based on the patient's disease for caregivers to select. After selecting the observed symptoms, the information will be saved and doctors can easily access it.
CALENDAR - enable smoother hand-off between multiple caregivers
Caregivers can review past caregiving information from “Memorize” and “Report” by selecting a specific date on Calendar. As such, rotating caregivers can seamlessly exchange information and stay updated about the patient's conditions even if they are not always present at the hospital.
MESSAGE - allow multiple caregivers to directly communicate
Caregivers can leave messages through text or voice in WeCare, and the rotating caregivers will be able to get the message once they enter the hospital room.
EAT - allow caregivers to order meals from hospital rooms
With this feature, caregivers don’t need to bustle around in the hospital food court during meal time and can order meals from the hospital cafeteria in hospital rooms. Therefore, they will have more time to interact and chat with patients at leisure.
1st Usability Testing
I tested the 5 features in randomized order using think-aloud protocol with 10 caregivers and medical personnel.
Uncover users' expectation of each feature:
Can this feature fulfill users’ need; what are the benefits and concerns?
How do users navigate through this feature and does the experience match their expectations?
The feature, “Message,” is unnecessary for caregivers:
For the purpose of messaging other family members, most users expressed that they are accustomed to using Line, the most common messaging tool among the older population in Taiwan, and will not want to switch between platforms.
Providing access to all past data on “Calendar” will be helpful for doctors:
According to doctors' feedback, they would like to view a patient’s symptoms and conditions over time so they can evaluate the progress.
The information hierarchy is not clear:
Currently, “Memorize” is set as the default homepage without a home button, which causes confusion for users who are less tech-savvy. We will provide corresponding buttons for all the features to make information hierarchy clearer.
Icons without text labels are confusing:
Icon alone is not enough to convey meaning and functionality to users, and older users are afraid to tap on icons when they are not sure what will happen.
Color can contrast more and be more vibrant:
Many users expressed that they think the color of the background and different elements can contrast more, so it will be easier to read. Also, they think a more vibrant color palette will bring up a sense of warmth, which is aligned with the purpose of this app.
2nd Usability Testing
After redesigning the features, I conducted usability testing using think-aloud protocol with 5 caregivers and 1 doctor. The purpose is to understand if caregivers can successfully complete the tasks and to identify room for improvement.
Prototype & Tasks
Note: prototypes were translated into English.
It's 10am in the morning, the patient needs to drink 1800c.c. of water in the morning.
Finish the task when being notified.
You think that the patient is coughing more than usual is feeling sleeping even though he/she just woke up 1 hour ago.
Record the symptoms that you just observed.
It's lunch time and you
Check the patient's condition from yesterday.
It's lunch time and you want to have some quality time and chat with the patient while you eat, so you don't want to go to the cafeteria.
Order lunch from the hospital room.
Caregivers found the interface easy to navigate on and all of them successfully completed the tasks.
Caregivers were excited about WeCare and think it could improve their caregiving experience at hospitals.
The doctor thought WeCare will make communication between them and caregivers more effective and enhance their understanding of patients’ conditions.
“I think hospitals should have provided this service. This would have saved me so much time and make my role as a family caregiver less difficult."
- Tiffany (caregiver)
"I think the features, Report and Calendar, show great potential, as it often takes a lot of time for doctors to learn about the patient's symptoms. It will be absolutely helpful if we can get the latest update on the patients' conditions and track their progress over time."
- Jack (doctor)
Be flexible and improvise when conducting qualitative research:
No matter how many discussions we had or how thorough our study plan was, there were going to be unexpectancies that were out of our control. For example, participants forgot to show up or there were technical difficulties with our devices. All we could do is to problem solve whenever these things occur and improvise along the way
The importance of considering participants’ diversity:
As most family caregivers are middle-aged or senior adults, their technology literacy is different from that of younger generations and they also have certain physical limitations. Therefore, how our users interacted with technologies were very different from what we expected. Only by directly talking to these people and observing their usage can we understand their needs and limitation to design an application that is useful for them.
Fast iteration and validation enable faster learning:
Conducing 2 rounds of usability testing allowed us to quickly validate our hypotheses and improve our original design solutions. Rather than trying to find the “perfect solution” and spending more time perfecting it, getting timely feedback from users allowed us to explore more widely at first and make our decision making process iterative.