Irith says: Good behaviour change should be about aligning people’s intrinsic desires with habits and behaviours that support well-being and health. Most people’s experience of behaviour change is different. That’s one of the things I’ve learned by researching how health coaching works.
Irith Williams works with a diverse team at HealthMap, based in the Infectious Diseases Unit, Monash University, Australia, focusing on HIV patients, and organizes the UX Book Club at Melbourne. Irith also talks about behaviour change and offers advice for user experience designers interested in healthcare.
Arun: Your current work of working with an inter-disciplinary team at HealthMap for creating a chronic disease self-management tool for people with HIV is exciting. Can you elaborate on the project?
Irith: HealthMap is an Australian National Medical Health and Research Council funded project. HealthMap is about to go into a cluster randomised control trial at HIV treatment clinics in a number of Australian states. I think there will be about 300 participants. The goal of HealthMap is to support self-management for the chronic conditions of ageing: heart disease, stroke, and diabetes. As with the general population these are the most common morbidities for older people with HIV, but having HIV makes managing them more complex and problematic.
The scope for HealthMap is very ambitious. It ranges from encouraging patients to discuss personal concerns with their HIV treatment provider, to supporting smoking cessation, to encouraging a cholesterol-testing regime to addressing issues around social isolation. It potentially encompasses mobile platforms, a clinic-based web app, a patient portal and phone-based health coaches.
Arun: One of your interest areas is in behaviour change. As a user experience researcher in healthcare, where do you see the importance of behaviour change?
Irith: Well, policy makers have identified behaviour change as the way to attempt the control of burgeoning health system expenditure. The bottom line is that taxpayers would have to spend less on the healthcare system if everybody stopped drinking sugary drinks (for example). Good behaviour change should be about aligning people’s intrinsic desires with habits and behaviours that support well-being and health. Most people’s experience of behaviour change is different. That’s one of the things I’ve learned by researching how health coaching works. Health coaches aim to equip people to recognise their own personal drivers for change and their own barriers and develop individual strategies to overcome those barriers.
Arun: You like designing beyond screens. What are the challenges involved?
Irith: I guess what I might mean by that is that I like a design approach that encompasses the big picture. It needs to be strategic. There could be plenty of solutions for which digital is only a part. There are a lot of constraints imposed by designing for a clinical trial, so where a true design approach would have room to try different iterations and test design efficacy in different directions designing to produce a program that has to be evaluated with a particular rigour and by a certain date can be more narrow. There are all the usual challenges of stakeholder relationships and competition for resources; it’s just that in the healthcare sector they have their particular context and patterns.
Arun: With wearable and pervasive computing technologies slowly becoming a reality, do you see people embracing these changes in their day-to-day lives?
Irith: I certainly see ubiquitous computing happening. I wouldn’t say the same about ‘wearables’. The research we did for HealthMap showed that almost 70% of our participants had smart phones. They didn’t all access the Internet via their phones, but many did. It’s also a generational thing. Most young people in Australia will own a smart phone or tablet at some stage. They will just see it as ‘normal’. Although data is very expensive in Australia compared to the UK and Europe. At the moment there is an economic barrier to web-based information. I think that’s very worrying as more and more information is only available via an Internet connection.
Arun: You have created a LinkedIn Group “Designing for Health in Australia” and also organize the UX Book Club, Melbourne. How has this helped you professionally?
Irith: As far as UX Book Club goes the most significant help has been to build a network. I moved from Sydney to Melbourne and had one connection in the UX field. I’m also a compulsive networker, so it was just my natural habitat in a sense. So if you want to build connections, roll up your sleeves and start helping somewhere.
If you participate in and facilitate community-based events it gives you a profile. I actually didn’t realise this until I’d been facilitating the Book Club for about a year and I attended an event and people who I’d never met knew who I was. That can be helpful if your goal is to build a profile. The other thing that happens is because you have a profile people make assumptions about your abilities and knowledge. I’m very aware of not wanting to give people false impressions of my skill set and levels of experience. I think anyone who is a quality designer will value honesty and openness about areas that need development, I don’t want to ‘sell’ myself, I want to build relationships based on trust and respect.
The goal for “Designing for Health in Australia” isn’t about me at all. Although it will give me a profile I’d prefer that my activity would diminish and it became a self-sustaining forum for dialogue. We only began in September, so it’s early days yet! Health design in Australia straddles academia, medical institutions, private agencies and LOTS of small startups. There’s a huge need for cross-pollination and sharing of expertise. There’s also a need for a conversation around an Australian context, as there are major differences between Australian and overseas healthcare systems.
Arun: What are the exciting start-ups in healthcare that you follow?
Irith: I attend the Melbourne-based Healthtech Startup meetup and there are some fantastic case studies shared.
I’m aware of startups like ‘Sessions‘ which are also in the behaviour change field. There are also startups like ‘ManageBGL‘ that have huge potential.
There are a lot of doctors who code and write their own apps to support their own work, which is very exciting. ‘StethoCloud‘ is a good example of that.
Arun: What words of advice would you offer for user experience designers who are interested in healthcare?
Irith: I think this would apply to any field actually, but I would say ‘build relationships’. Attend health-related meetups and hack events. Even better would be to build relationships with academic design researchers and medical researchers. In Australia the whole institutional structure of healthcare and health funding is interwoven with academic research. There are some really cool projects out there just crying out for design input. My observation is that people understand they need funds for ‘software development’ (which means engineering) but no idea that there is a whole parallel design activity that needs to happen. Make connections and educate people about how design can solve problems. In healthcare design is very much about shaping scope and requirements. That’s very important.
I would also say be aware that there is a huge need for stakeholder education in User Experienced Design as an evidence-based process. All the familiar issues from the corporate world about ‘Why do you need to do research? We already did surveys.’ still exist, but they have their own flavour that comes from the medical world and academia. Be patient and be prepared to explain why you work the way you do.
In Australia I would definitely advise designers to rethink their revenue model if they want to work in health. Hospitals and universities don’t have the same budgets as the corporate world. Grant-funded projects don’t have lots of flexibility in how funds are spent. I don’t know of any health projects that could afford top shelf UX freelance rates. There are a minority of ‘for profit’ health companies operating in Australia. I think the government sector may have more freedom, but I don’t have any experience of that.
Thoughts on Services and Design 