MoleCare (Case Study) - Part 2

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Field Study

AIM OF THE STUDY

The aim of the field study was to answer the following questions:

  • RQ1: To what extent can a design intervention, which focuses on stimulating reflective and automatic motivation, change attitudes of less activated patients towards SSE?

  • RQ2: To what extent can a design intervention, which focuses on stimulating reflective and automatic motivation, form intentions in less activated patients to start doing SSE?

  • RQ3: What strategies are most effective in changing attitudes of less activated patients towards SSE?

  • RQ4: What considerations must be made when designing an intervention focusing on reflective and automatic motivators for a change in SSE behavior of less activated patients?

PARTICIPANTS

I recruited 8 people to participate in the study with relatively loose inclusion criteria of... • They must have been over the age of 18 • They must have used an Apple smartphone.

Part 2 • MoleCare • Digital Healthcare

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Want to learn more about the design process?

1. Study Structure

The field study design consisted of 3 phases:

Before the usage

  • Pre-study participant questionnaire To gather data on participants demographics as well as gather and measure data on participants’ current attitudes and behavior towards SSE

During the usage

  • 2-week period using the program Participants were asked to use the program for 2 weeks. After each week the usage data was collected.

After the usage

  • Post-study questionnaire and interview to understand persuasiveness of the program and user experience with the program

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        During the study, the researcher performed a set of activities to replicate some functionalities that could not be developed in such a short timeframe.

1. Personal Challenge

Prior to the field study, a 2-week challenge was created for participants to stimulate their engagement with the program by setting a Goal for participants; the

the challenge was to listen to at least 6 podcasts over the period of the study, which was realistically attainable and hence was meant to empower participants.

 

2. Before the Usage Period

Before the study started I asked participants to complete a questionaiare to capture their initial attitudes towards SSE as well as get thier demographic data.

This was important in order to understand how representative of a general population the group of participants was.

  • Age. The majority of participants were in the 18 - 30 age group. Even though this makes the participants less representative of the general population, it has been found that age does not have a significant effect on people’s tendency to do regular SSE.

  • Gender. Data revealed that the gender of participants was fairly well distributed between male (3) and female (5). Although similar to age, gender does not significantly impact the choice of adopting regular SSE.

  • Education. Data showed that over 80% of participants held either bachelor’s or master’s degrees, which is higher than the population average of just slightly over 40%. It has also been found that "higher education is associated with more frequent SSE at pre-diagnosis". 

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OUTCOME

To summirise, the group was representative of the general educated population, however the results of this study may not apply to people who do not have a university degree.

3. During the Usage Period

In the middle and at the very end of the usage period, I took a number of metrics to understand how participants used the program:

  • Total engagement with the app in the middle and at the end of the study

  • Number of podcasts listened by each participant

  • Number of photos of moles taken after listening to podcasts

3.1 Engagement Observations

​Total engagement level with the program mimicked the engagement with podcasts, which suggests that podcasts and associated functionality was the primary persuasive source.

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KEY OBDERVATIONS
  • Participants listened to more podcasts during the first week, which could be partially explained through the pre-study planning activity they were asked to do.

  • 6 out of 8 participants successfully completed the challenge and listened to 6 podcasts.

  • Half of participants continued using the program after the challenge was completed, suggesting that the challenge itself was not the main motivator.

3.2 Number of Photos Taken

One of the main measures of behaviour intention, and hence the overall effectiveness of the program was the number of photos taken.

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KEY OBDERVATIONS
  • More than half of participants took a photo at least once, suggesting behaviour initiation.

  • 1 Participant kept taking photos with the same frequency as he listened to the podcasts. This behaviour is way beyond the expectations and needs further investigation.

  • Most participants took an expected number of photos: from 1 to 2 photos. This is ideal for regular SSE.

 
 
 
 

4. After the Usage Period

At the end of the study period I have asked participants to complete the same questionnaire that they have completed before the study started and invited them for a Zoom interview. Following the principle of triangulation, the aim was to get both qualitative and quantitative data to improve the validity of the results.

4.1 Attitude change

  • 5 participants admitted that skin SSE does not take much time. On average, participants claimed that ‘a lack of time to perform SSE’ was less applicable to them after the period of using the program.

  • What was also quite striking is that 5 participants became more serious about SSE and about the consequences of not doing it regularly. In essense, participants’ awareness of SSE increased.

  • Another intersting obersvation was that two participants changed their perceived social norms regarding SSE, which in turn changed their attitudes towards adopting SSE without being afraid of social judgement. 

These findings answered RQ1.

QUOTE

‘I feel like getting done in three minutes sounds like a good idea. And it's not too little, not too much.’

‘I'm definitely more aware and it's in the back of my mind that I need to do it whereas I didn't think about it before (..) just kind of didn't think about it at all and now I do’

‘So, if I see someone doing it, I won’t think that they are doing something weird or whatever, unlike before.

4.1 Behaviour change

  • Current behaviour also improved. Not only participants were observing their skin almost twice as much as they did before, this time most of participants were engaged into a mindful SSE i.e. taking photos of their mole for the future reference. Only two participants did not take any photos during the period of the program’s usage.

  • A change in behaviour intention was reported by the majority of participants. 3 participants reported their intention to continue using the program or doing SSE on a regular basis. 

  • 4 participants also reported that they have noticed themselves paying more attention to their skin. 

        Most participants decided to take photos of their moles after listening to a padcast! View metrics in secton 3.1 and 3.2

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QUOTE

“I actually started thinking that like (..) you should think about skin self-exam sometimes I guess.’

“I think the program helped me to look at my skin more often (..) which is a good thing and I realised that I have more moles, so I did not know I had so much moles”

4.1 Behaviour change

  • Current behaviour also improved. Not only participants were observing their skin almost twice as much as they did before, this time most of participants were engaged into a mindful SSE i.e. taking photos of their mole for the future reference. Only two participants did not take any photos during the period of the program’s usage.

  • A change in behaviour intention was reported by the majority of participants. 3 participants reported their intention to continue using the program or doing SSE on a regular basis. 

  • 4 participants also reported that they have noticed themselves paying more attention to their skin. 

        Most participants decided to take photos of their moles after listening to a padcast! View metrics in secton 3.1 and 3.2

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QUOTE

“I actually started thinking that like (..) you should think about skin self-exam sometimes I guess.’

“I think the program helped me to look at my skin more often (..) which is a good thing and I realised that I have more moles, so I did not know I had so much moles”

4.3 Obstacles to SSE

The data suggested that the obstacles to SSE were captured at the begining of the study were reduced by the end of it. 

  • Participants claimed that ‘a lack of good reason to start performing regular SSE’ as an obstacle was somewhat not applicable to them anymore.

  • Participants also suggested that ‘the absence of family history of cancer and weird symptoms’ was somewhat not applicable to them anymore, compared to previous rather neutral opinion.

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        Findings in the small deck below address RQ4

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Program Adoption Barriers
Learn more about the barriers of the program adoption from these slides 

4.4 User Experience

The analysis of the UEQ results concluded that overall the program was rated as ‘Excellent’ compared to the General Benchmark.​

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INSIGHTS
  • Interestingly, Hedonic Qualities outperformed Pragmatic qualities of the program, which could be potentially caused by a relatively low score for the program’s predictability. This could be partially explained though a serious of bugs at the beginning of the field study.

 

  • Creative side of the program as well as its clarity were rated the highest compared to other qualities of the program

  • Similar to UEQ results and aside from a number of bugs, all participants found that the program was easy to use and claimed that they found it not only beneficial for themselves but also pleasurable to use. 

  • Friendly and positive design was reported to set the appropriate tone to let participants feel comfortable when using the program

QUOTE

‘I liked the look and feel of the program, it was really positive and friendly.’

‘The colours were nice; they were not typical (..) and I think it’s important for the app concerning a health issue to have a friendly and positive design like that.’

So what?

Based on the results of the field study, design guidelines were created to make suggestions for those designing for a change in attitudes and behaviour towards SSE, using reflective and automatic motivators.

 

5. Study Limitations & Reflection

  • Timeframes allowed for this project directly influence the time period for the study. In addition to pretty short deadlines, in the middle of the project period I reliased that I spent too much time on participants’ reqruitment which was not happening at an estimated speed. Due to the time constraints, I had to shorten the field study period from 4 weeks (sufficient period) to 2 weeks, which in turn made it impossible to observe the changes in attitudes and behaviour in the long run.

  • Recruitment by itself posed some limitations. Since the study focused on motivation, it was not feasible to provide a monetary incentive for people to participate in the study as that would bias the results. The decision was made to recruit people from social media meaning that participants were my acquaintances or friends. This fact posed doubts on the validity of the data, in particular on the validity of the average engagement with the program.

  • I also did not have sufficient time to pilot user-related activities and assets e.g. as user testing. The downsides of not doing pilot studies were most prominent for the field study, where participants experienced a few major bugs for the first 2 days of using the program.

  • Development resource together with the time constraint, has also limited the way the actual build looked like compared to the final Figma prototype. Descoping helped to mitigate this issue to some extent.

 

6. Project Outcomes

  • I successfully investigated barriers to SSE associated with reflective and automatic motivation among people with no intentions to perform the target behaviour.

  • I used the insights from the research stage to design a novel persuasive intervention built as part of the existing MoleCare application. Through the field study, I got evidence that this intervention is capable of improving people’s attitudes towards SSE and facilitating formation of behaviour intentions, at least for the short term.

  • From the findings of the field study, I also created design guidelines for those creating persuasive technologies that target reflective and automatic motivation to improve attitudes towards a positive health behaviour.

  • Apart from the guidelines, I hope that this project and its findings will benefit health behaviour change field, by exposing undervalued motivators and corresponding techniques investigated during the course of this project.