eyeGuide is a computer-based personalized behavior change program that enables medical assistants with brief training to motivate and support glaucoma patients to improve their self-management and medication adherence.
8 weeks, 2015-2016
UX & UI designer
Ann Arbor, MI
In this NIH-funded study: Improving Glaucoma Self-management with Technology-supported Counselors. The first cohort of the Stamps Master of Design (MDes) in Integrative Design collaborated with Paula Anne Newman-Casey, MD, Assistant Professor in the Department of Ophthalmology and Visual Sciences at University of Michigan Kellogg Eye Center on refining and piloting test the eyeGuide, a computer-based personalized behavior change program that enables medical assistants with brief training to motivate and support glaucoma patients to improve their self-management and medication adherence.
Globally, glaucoma is the leading cause of irreversible blindness. In the United States, the prevalence of glaucoma increases from about 2% among those over the age of 40 to 10.3% among people 75 and older. Because the number of adults over the age of 75 will more than double between 2010 and 2050, the number of people living with glaucoma in the US will increase substantially.
Some facts about Glaucoma
Despite the availability of effective medications to treat glaucoma, glaucoma remains the third leading cause of blindness in the US. One important reason that glaucoma continues to cause vision loss is poor medication adherence. At least one-third and potentially up to 80% of glaucoma patients are poorly adherent, with approximately two-thirds of glaucoma patients failing to return consistently for follow-up visits. Patients with poor adherence to glaucoma medications have worse outcomes, with more severe visual field loss compared to adherent patients.
Resolution of the challenge
Most of the successful interventions to improve medication adherence among glaucoma patients have employed individualized approaches through one-on-one counseling. This builds on a significant body of evidence demonstrating the benefits of interventions that tailor health messages by individualizing the information and behavior change strategies to reach each person based on characteristics unique to that person. Tailored educational content can be delivered through a variety of methods: in a web-based module, in print or in-person. The project was to redesign the eyeGuide, a tailored behavior change program for glaucoma patients. The eyeGuide’s content is individualized to each patient’s medical record and it addresses barriers to optimal meditation adherence by sharing tailored testimonials from patients who have overcome challenges with medication adherence.
Understanding the context
In order to better understand the context of the challenge, we visited the glaucoma clinic to talk with our client and observed the patients, medical assistants, techs, fellows and physicians. These field work experience provided us a holistic view of the care team’s roles and their working process in the clinic. It also helped us to systemically analyze the problem from multiple perspectives instead of only focusing on single aspect of the stakeholders landscape. Based on the research findings, we came up with a service blue print to illustrate the current system and identified the opportunities (missing/weak touch points) which could improve the patient experience and work efficiency of the care team significantly.
Analyzing the existing eyeGuide
The existing eyeGuide consists of two tailored components: glaucoma education and patient testimonials. Bullet points and images were used according to the Center for Disease Control’s (CDC) Clear Communication Index for improving health communication.
The intent of the eyeGuide development is for supporting a discussion between a patient and a health care provider trained to improve the patient’s motivation to adhere to their glaucoma medications. Through a comprehensive analysis of the existing eyeGuide (website) by going through the complete information architecture, user interface and content, we raised several questions, assumptions as well as insights to lead the first round of ideation and conceptualization phase.
According to the contextual research and existing eyeGuide analysis, we came up with some paper prototypes to visualize patients’ journeys and exam results in the glaucoma clinic. We also reframed the eyeGuide website into four new parts which are Learn, Use, Goal and Plan. Each part includes updated, understandable and comprehensive glaucoma information. By creating a wireframe to clarify how to arrange these information and a basic UI prototype to navigate the users, we were able to demo these initial concepts with our target users and collect their feedback for the further iterations.
1st patient advisory board
In oder to test our assumptions and ideas in the first round prototyping, a patient advisory board was organized. Besides the design team and our clients from the Glaucoma clinic, three patients and one caregiver were recruited. We used a semi-structured interview guide based on our previous research findings to elicit feedback about the prototypes.The interview guide also included broad questions about the overall acceptability of the intervention, whether the subject had additional barriers to optimal glaucoma medication adherence, and whether the subject would rather use the program independently on a computer or with a paraprofessional at the doctor’s office. This session was audio recorded and transcribed verbatim.
In our qualitative analysis of the transcribed interviews, we found that many older patients rely on support systems to help manage their glaucoma. Thus, future iterations of the eyeGuide will include social support as a tailoring variable. Older patients also had a harder time with eye drop instillation. Going forward, we will address this by teaching eye drop instillation as part of the eyeGuide behavior change program.
Information Architecture & Wireframing
User Interface Before & After
Before - Login Page
Before - Patient List
Before - About Glaucoma
Before - Visual Field Progression - 1
Before - Visual Field Progression - 2
Before - Barriers - Questionnaire
Before - Barriers - Stories
Before - Action Plan
After - Login Page
After - Patient list
After - Main Page
After - About Glaucoma
After - Visual Field Progression
After - Barriers - Questionnaire
After - Barriers - Stories
After - Action Plan
2nd patient advisory board & Work in the future
After testing the usability of the new eyeGuide with the same group of patients and caregivers we interviewed before, our project moved into the final realization phase. In the summer of 2016, one of the MDes team members conducted his internship in the glaucoma clinic to come up with the content(video/audio) of the website and work with developer team on launching this application.
The new eyeGuide transformed eye care delivery from a provider-centered to a patient-centered model successfully. Implementing personalized behavior change programs such as the eyeGuide into clinical practice will greatly improve patient satisfaction with their glaucoma care.