Designing a digital toolkit that informs and empowers cardiac rehab patients.

British Heart Foundation
Product & Graphic designer
Mar 2016 – Oct 2020

Background

Cardiac rehab helps patients get back to as full a life as possible after a cardiac event such as a heart attack, heart surgery or stent procedure. It is a vital part of long-term recovery – as important as taking medication.

Cardiac rehab is an individualised programme run by healthcare professionals (HCPs) and is made up of exercise, education sessions and emotional support. Many cardiac rehab centres run two sessions a week for up to 12 weeks in a hospital or community setting such as a leisure centre.

The brief

To develop a digital product to support patients who cannot attend their cardiac rehab programme. The aim is to help keep patients safe and out of hospital by keeping them informed and motivated, and to support them in maintaining a self-care routine.

I formed part of a working group consisting of a Product Manager and members of the Healthcare Innovation team including clinical and patient representatives.

Empathy mapping

To begin with, I facilitated remote exercises in empathy mapping using Miro in order to capture the team’s combined customer knowledge and map out user attitudes, behaviours, needs and paint points. Following the session, the facilitators grouped the sticky notes into categories to help identify emerging themes.

“The workshops provided an excellent approach to gathering insight across multiple teams with varying experience of cardiac rehab delivery. The sessions were facilitated extremely well and everyone felt listened to and that their views were valued. Miro provided a great visual! It gave a face-to-face interactive feel to the workshop even though it was delivered remotely. We could really see the product starting to take shape through the eyes of our personas.” — Health Services Engagement team

Persona 1: Patient looking to start cardiac rehab having had a recent heart event

Persona 2: Patient who has started cardiac rehab and is looking to maintain

Persona 3: HCP involved in the delivery of and signposting to cardiac rehab

Personas

The empathy mapping exercise above was used to inform our three key persona profiles. These profiles will be used as a reference at every stage of the project.

Persona 1: Patient looking to start cardiac rehab after having a heart event

Persona 2: Patient who has started cardiac rehab and is looking to maintain

Persona 3: HCP involved in the delivery of and signposting to cardiac rehab

Competitor analysis

I investigated fourteen competitor health apps and websites and presented the findings back to the working group. These included Macmillan Cancer Support, Babylon Health and Headspace Inc.

I shared the findings in an article written for The Brand Blog, titled 5 ways that charities can use gamification for good. The blog supports charities by sharing expertise from across the industry.

Online survey with MVP users

I then set up and analysed results from a Qualaroo user survey that launched on the MVP landing page and surrounding pages on desktop and mobile.

826 users participated in the survey. The feedback is being used to ensure we're providing the most useful and relevant information for our users now and in the long-term.

Quantitative feedback

Qualitative feedback

The following themes emerged in response to the question ‘Can't find what you're looking for? Please let us know what information was missing from this page’:

• Assessments

• Condition information

• Exercise information

• Exercise videos

• Speaking to someone directly

Most commonly, users stated that they would like to be able to speak to a healthcare professional directly, questioned how they could get a cardiac rehab assessment and requested more exercise videos with accompanying instructions on how often to do them.

TWO MONTH REVIEW (30/06/20)

The above feedback has been incorporated to ensure that the MVP pages better fit the needs of our users. In June, I ran a follow-up survey to measure confidence. 98% of 247 users said the provided information made them feel more confident about doing cardiac rehab at home, an increase of 11% since April.

Research insights summary

There is currently a ~50% uptake of cardiac rehab services.

Market insights

Too structured/inflexible

Overly structured programmes with too much focus on medicalisation can lead to the patient having to fit around the programme, rather than the other way round (Recovery & Support HSE Position Paper).

Appeal

There is currently a ~50% uptake of cardiac rehab services. In order to reach the target of 85% by 2028, the model will fundamentally have to change (Recovery & Support HSE Position Paper).

Inequality in the current system

Cardiac rehab is a postcode lottery. Some people with pre-existing mental health conditions may not be able to access classes. Plus those with mobility issues and those whose driver’s licences have been taken away after a heart event may not be able to physically get to the class.

Impact of coronavirus

The impact of coronavirus on service changes and closures are expected to impact both HCPs and people affected by HCD for up to a year (British Heart Foundation covid-19 Insights).

Creating a wider sense of community can help people feel more connected to others.

Competitor insights

Personalisation

Many health and wellbeing products tailor their service to the specific needs of their audience. They allow users to set interests and help them maintain routines through personalised checklists, schedules and reminders. They enable users to add appointments to their calendar and use push notifications to help keep them on track.

Community

Creating a wider sense of community can help people feel more connected to others. Some competitors display how many people are using their product right now. And others promote adding friends to support the user and help them achieve their goals.

LOGGING AND TRACKING

Allowing users to track progress over time can help them maintain a routine, help visualise their progress, and seek support in areas in which they’re struggling. One app acknowledges that people express themselves in different ways by offering multiple ways to track mood and activity.

ACHIEVEMENTS AND REWARDS

Unlocking achievements and rewards can make for a fun experience and add a competitive element.

CHALLENGES AND GOAL SETTING

Setting challenges with achievable, realistic goals can create a sense of satisfaction and keep users returning to the product. One app allows friends and family members to send the patient motivators such as vouchers to keep them on track and feeling supported.

Journey mapping

Next, I facilitated a remote journey mapping exercise using Miro to identify the stages of the end-to-end patient experience. We used sticky notes to map ideas that could support our audiences at each of these stages.

“The pre-workshop communication and task introductions ensured that participants were coming informed and prepared to engage fully in the session. Having a swift turnaround of the workshop materials added to the experience: having sight of the finished visual so you could formulate thoughts and reflect was so beneficial.” — Health Services Engagement team, British Heart Foundation

Journey 1: Patient with good intentions

“I want to be proactive in managing my health and preventing the same happening in the future.”

• The patient may want to take proactive steps but doesn’t know where to start

• They may be motivated to recover for their family

• They may not understand the benefits of cardiac rehab

• They may have identified their own recovery plan

Journey 2: Patient who is lacking motivation

“I’m scared and overwhelmed by what’s happened – I don’t see a way out of this.”

• The patient may be feeling helpless, anxious or depressed

• They may not be aware of the benefits of cardiac rehab

• Cardiac rehab does not sound appealing to them – they do not identify with the people that attend it

• They may identify barriers to attending e.g. work, family commitments and accessibility issues

SAPS model of motivation

I then mapped our patient and HCP personas against the SAPS model of motivation. The goal of the framework is to identify rewards (status, access, power and stuff) that could help keep users motivated and engaged.

Patient looking to start cardiac rehab after having a heart event or patient who has started cardiac rehab and is looking to maintain

Status

• Number of physical activities completed

• Number of personal goals complete

• Number of videos watched

• Number of posts on patient forum

• Wall of fame

• Cardiac rehab programme complete

• Case study feature on BHF social channels and in cardiac rehab-related emails

Access

• Access to bespoke, expert support including articles, videos, podcasts, FAQs and print materials

• Access to a wide network of cardiac rehab patients for community support

• Ability to allow family to access progress (support, motivation)

• Access to personal data/progress

• Access to cardiac rehab email journey

• Access to family support

Power

• Power over when and where to participate in cardiac rehab programme (flexibility)

• Ability to set personal goals and log progress (self-assessment)

• Ability to link with relevant apps e.g. Strava

• Choice over personal preferences e.g. push notifications, reminders

• Ability to provide feedback to the BHF to improve service for themselves and other patients

• Ability to save and share support information

Stuff

• Digital badges/medals to celebrate progress (rewards)

• Certificate on completion of the programme (digital, printed or both)

• Relevant BHF-branded merchandise for example, exercise mats and resistance bands

HCP involved in the delivery of and signposting to cardiac rehab

Status

• Number of patients helped

• Number of resources shared with patients

• Number of talks/podcasts given

• Number of mentions in the news

• Leaderboards based on constituency or hospital

• BHF-approved title/status

Access

• Access to a wide network of HCPs including nurses, physios, dieticians, pharmacists, physical activity specialists and occupational therapists

• Access to learning materials including articles, videos, conferences and podcasts 

• Access to patient information in order to provide personalised support

• Access to patient feedback (learning and development opportunity) 

• Access to exclusive professional development events including group sessions and talks

• Support in getting papers published

• Journal membership/subscription

• Access to mentors

Power

• Power to help patients in a more accessible way – online/remote support

• Choice of materials that can be self-selected, curated in a list and shared with patients

• Ability to provide feedback to improve service for themselves and their patients

Stuff

• Promotion on BHF social channels (LinkedIn)

• Promotion in Heart Matters magazine

• BHF-approved badge (digital, physical or both)

• Certificate from the BHF based on number of patients helped/resources shared 

• Annual magazine membership (health, science and research)

• Vouchers for their hospital/surgery e.g. for equipment

Ideation exercise

The facilitators took the ideas from our journey mapping and SAPS exercises and categorised them in FunRetro by:

1. Quick wins

2. Achievable within three months from now

3. Achievable within a year from now

We shared the link via Microsoft Teams, explained how voting works and encouraged the working group to elaborate on ideas using the comments feature. We then asked them to vote for their top three favourite ideas in terms of what would benefit our audience the most in each column.

Value/effort matrix

Following the FunRetro exercise, the facilitators input all the voted ideas into Miro. We then reviewed and plotted them on a value/effort matrix to determine the feasibility of each idea and identify those that required further investigation.

Article on remote collaboration

Following the workshops, I co-wrote an article for BSC, The Chartered Institute for IT titled Remote working: how to drive innovation and collaborate effectively. We discuss our experience of running virtual workshops using collaboration tools.

“A respectful and inclusive guide about how to utilise online collaboration tools and workshopping techniques to foster an inclusive culture that nurtures the ideas of team members – of all pay grades – while working remotely.” ⁠— Johanna Hamilton, Commissioning Editor at BCS, The Chartered Institute for IT