Case Study: Digital Behavior Change Intervention in HealthTech

Project Overview

As Feature Lead and User Researcher, I was tasked with leading research to support developing content and interactions for a digital behavior change intervention (DBCI) aimed at a global HealthTech market.  A primary focus was ensuring compliance with regulatory standards, including Pharmacovigilance, HIPAA, and GDPR across EMEA and North America.

DBCIs are interventions that use digital technology to encourage and support behavior change that will maintain or improve health through the prevention and management of health problems and can, for example, be delivered through computer programs, websites, mobile apps, or wearable devices 

This case study shows how I carried out research to identify a gap in patient support, validated concept designs and provided evidence of improved patient outcomes. 

Alex Tarling at AktivResearch, stood up the research team to develop the product for a well known global pharmaceutical based in the Germany. We worked closely with Alan Hamilton our clinical science expert in pulmonary health, and Kim Lavoie Canada Research Chair in Behavioural Medicine. We collaborated with Lindsey Castro a senior designer at Medullan (USA) who have a great track record for interaction design for digital health.

We worked collaboratively across Canada, the USA, the UK, Germany and France.

To secure the next round of funding, we needed robust evidence of behavior change among patients who had been resistant to alternative treatments. This evidence would validate the DBCI’s effectiveness and justify further investment.

The hypothesis was that providing patients with a means to track symptoms would support them to make incremental behaviour change over time and improve patient outcomes.

It was important to the study that participants were patients who had shown resistance to behavior change. If successful our product would demonstrate a need in a niche where medical interventions had failed.

As preparation for the study, I carried out a literature review. This helped me to familiarise myself with motivational interviewing and pulmonary health research. 

A review of functional medicine gave me insights into how patients talk about their symptoms as preparation for the design workshops and to inform the discussion guides. 

It was clear that a study would need to follow patients over several weeks if we were to provide evidence of positive life-style changes brought about by using our proposed mobile app. As a cross-border project we would need to comply with stringent regulations for both EMEA and USA. 

I designed a longitudinal study based on patient interactions with a prototype designed for mobile devices using Landbot. The study would track patients over a 5 week period to evaluate if there were any changes to their behaviours that would improve patient outcomes. 

As the research plan was going through the approval process, I carried out some desk research, reviewed previous studies and gathered insights from public online forums. 

An analysis of this revealed patient challenges and gaps in support. So, I proposed an alternative design feature that we could test alongside the original proposal for a tracking tool.

The findings from the desk research would guide our design workshops with clinical experts and help us to develop a prototype design for use in testing. 

The desk research had revealed compelling evidence of a gap in provision of support for patients emotional wellbeing that our clinicians were happy to support.

 So In collaboration with our team of experts, I mapped out two core features for the health intervention:

• Symptom Tracking: To monitor patient symptoms over time.

• Emotional Wellbeing Support: To encourage reflection and support emotional health.

With both features agreed we  sketched out our  "happy paths".

Using Landbot, I integrated insights from stakeholders to create a tracking tool based on a chatbot. Alongside this I designed a feature to support self reflection. I produced wireframes and interaction pathways, handing off the design for technical implementation by developers.

I also worked closely with Medullan on an interactive concept in Figma that we tested in interviews. 

I followed 8 participants based in the USA over a 5 week period to find out if using the mobile app would lead to any life-enhancing behaviour changes.

The primary research began by benchmarking patients existing behaviours and surfacing key challenges. We then gathered information using the interactions with the Landbot mobile app, to understand how they were using it. Exit interviews with participants enabled us to do some user testing on the Figma prototype,  gather further insights, and identify any evidence of change that might affect their long-term health outcomes.

A narrative framework was used to create visual maps and written case studies recording patient behaviors, insights, and behavioral changes over time for each participant. Behaviour changes that would lead to improved patient outcomes were highlighted.

Detailed thematic analysis helped us to understand patient challenges and experiences as their disease progresses. Quantitative views of logging behaviours were created in excel. 

The results demonstrated significant impact:

• 43% of participants were able to implement changes in their lives that would positively impact their health outcomes.

• An additional over 28% reported gaining insights and making positive steps towards behavioral change.

We gathered evidence that patients had made positive changes to their 

• Behaviours, 

• Environments and 

• Relationships

Clinicians judged that these would result in enhanced patient outcomes.

This evidence was strong enough to convince clinicians that this feature should became the main feature of the DBCI. 

The study outputs included a narrative analysis, in-depth case studies, a thematic analysis, quantitive view of logging behaviours, and improvements to the interface gathered in user testing during interviews. Personas that highlighted the major turning points on their behaviour change journey. I presented the results to senior stakeholders. These would be used to inform design in the next stages.

I created a research library to hold all research outputs. I also captured our process in detail for auditing purposes.

The next step was to support the design towards Private Beta Release. I started this by running a series of “How might we?” workshops, starting by articulating detailed problems and providing a breakdown of design challenges. 

I created detailed "How might we?" statements to help us to think about the broader problems patients face, and consider options for design solutions.

The team brainstormed for solutions at different levels of granularity until agreement was made. These fed into a detailed roadmap for the next 3 -6 months and further 2 year timeframes. 

I drew up a detailed roadmap with the support of AktivResearch, Medullan, and our clinical experts.

The research findings revealed why patients were resistant to change and how we could better support them. We needed to make a significant pivot in the product as we switched away from tracking symptoms to providing support for reflection.

Over the next two months I provided design guidance for the amazing interaction designers at Medullan.  I made sure they clearly understood the gap in patient care our product was designed to address. 

I provided guidance for content design of scripts and animations highlighting common experiences, and use of language, to ensure our marketing would speak directly to the end customers.

The product went into Private Beta Release with a healthcare partner in the USA, and a further work package was proposed for the Service Design.

Senior clinicians proposed using my feature in a suite of products aimed at various health conditions where behaviour change intervention had been recommended by the scientific community.

It is great to know that the research we provided had a significant positive impact on patient outcomes!