Patient Portal for Non-Native English Speakers
Addressing barriers to healthcare access.
Role
Co-Research Lead
Timeline
Sep 2022 - Dec 2023 (Research)
Jan 2023 - May 2023 (Design)
Team
Design Lead, Co-Research Lead,
& Project Manager
Skills
Literature Reviews, User Interviews, Thematic Coding, Heuristic Evaluation, Wireframing, Prototyping
How might we enable healthcare equity for non-native English speakers?
CONTEXT
While pursuing my Master of Science in UX Research and Design, I collaborated with a group of like-minded students who shared the common objective of leveraging technology to tackle a global issue.
The healthcare industry is challenging for everyone, but non-native English speakers face additional linguistic and cultural barriers. This can lead to misunderstandings, communication issues, and difficulty accessing quality medical care. Limited accessibility and interpretation quality make it tough for patients to rely on professional interpretation services.
This project focused on the East Asian community, which has a particular distrust for eastern medicine. Our team’s goal was to develop a universally accessible patient portal for both native and non-native English speakers.
Healthcare constraints & distrust
PROBLEM SPACE
Mobile-first application
EXECUTIVE SUMMARY
This patient portal acts as a universal tool to assist non-native English speakers with their healthcare. Before an appointment, patients can select doctors in their native language or even book translators. They can also allow different members of their family to see personal records and results.
In the doctor/patient experience, a live transcription tool within the application can be used to facilitate better translation. Lastly, after the appointment, users can view notes or records and follow up with professionals with any questions.
Before we could begin our study, we needed frameworks to understand what barriers to healthcare access exist for marginalized communities, especially since no one on my team had a background in healthcare. My first step was turning to academic papers, which resulted in finding that access can be understood in three ways: organizational, structural, and clinical. These three elements acted as the baseline for how my co-research lead and I conducted our research.
Dedication to Exploratory Research
MY CONTRIBUTION
Literature Review: Barriers to Access
PRELIMINARY RESEARCH
Text Mining
It was also important that we understood the language and mental models of our users so that we can develop more targeted interview scripts that match how they describe their pain points.
Why study online communities?
The strength of text mining is that the anonymity given to participants in online community allows us to actual study the true honest experiences of our target audience, which may be subjected to social desirability bias in a more traditional interview format.
What did we want to discover?
What are the barriers/challenges that children face when helping their parents with healthcare?
What is the impact on the relationship between child and parent?
Defining Objectives
PARTICIPATORY JOURNEY MAPPING
After we did initial preporatory search, we then met with our actual users. It was important that our users were co-pilots in the study and so we opted for a participatory journey mapping workshop where we had users guide us in defining the step-by-step experience from awareness of health concern to post-doctor’s visit care. This journey map allowed us to understand the most challenging touch points between patient, caregiver, and medical staff.
Journey Phases
What is the step-by-step process from awareness of a health concern to post-doctor’s-visit care?
Caregiver Involvement
How is this patient-doctor experience mediated by the caregiver’s involvement?
Communication Challenges
What are the most challenging touch points between patient, caregiver, and medical staff?
Users articulated what tasks they needed to complete at each phase, followed by a discussion of their pain points. This allowed us to compare journeys across users to create an universal journey map.
While the participatory journey map was great at capturing more objective experiences, we then followed up with user interviews that allowed us to answer more abstract questions we had about cross-cultural differences in experience within healthcare.
We interviewed 10 patients and caregivers. Since our methods were qualitative, and our aim was not to produce generalizable findings (but rather to ground our design work in theoretical frameworks). It was critical that we were selective in who we recruited, so we relied on Purposive Snowball Sampling to isolate critical requirement criteria like age, role, and geography so that our samples are still diverse.
Purposive Snowball Sampling & Thematic Coding
USER INTERVIEWS
We strove to explore the following questions in these interviews:
What are the most challenging concepts/ideas to interpret that make patients feel disempowered with limited autonomy?
Are there culturally specific ideas/beliefs that are especially hard to communicate?
Outside of language needs, what quality of care differences exist when patients meet with culturally concordant providers vs. discordant providers?
After conducting the interviews, we utilized thematic coding to synthesize our notes using Dovetail software. When analyzing interview transcripts, we wanted to remove as much researcher bias as possible when deciding what were relevant key findings to focus on. We relied on both inductive and deductive categorization of themes to scope our research findings.
ESTABLISHING THEMES
Core Findings
The user interviews, participatory journey mapping, and text mining allowed us to gain a more clear picture on the struggles of non-native English speakers (and their families) regarding their healthcare. As the research phase came to a close, I initiated a meeting for our team to conglomerate our findings into key themes.
DESIGN PROCESS
Impact-Feasibility Prioritization Matrix
Within our themes, there were clear “How might we” statements emerging. We devoted time to writing these statements, and then I led the creation of an impact-effort matrix to determine which themes are the most important to tackle in our future prototype.
Crazy 8’s & Proof of Concept
Once we had our design criteria outlined, we picked 3 for our team to focus on in Crazy 8’s. We then consolidated our concepts into fleshed-out sketches and user scenarios. These were created for clarity and proof of concept.
Why conduct a proof of concept?
Validate/invalidate our concepts with users (n=5). We gathered insights and feedback from our target audience, and revealed areas for improvement in our solutions.
Brainstorming solutions and features for problems identified from research.
Sketches and user scenarios of proposed solutions to show users.
DESIGN
Defining Core Features
After the research phase, we began our process to prepare for prototyping. Before creating any wireframes or prototypes, we used competitive interaction mapping to get an idea of common information architecture and core features.
We then created the information architecture for our application, which included 7 core flows (defined below).
ITERATING
Creating user-centered flows
We relied on usability testing with each iteration to ensure that our prototype was solving our target users' needs. We synthesized our usability test findings in a spreadsheet where we organized the findings by frequency, allowing us to reveal and focus on the more pertinent issues. Every iteration included many crucial changes, but for the purpose of this case study I've outlined some noteworthy changes below:
ETHICS
Research ethics & inclusion
It is important to pause and discuss the importance of research ethics within our process, especially since our target audience is often not considered when designing health-tech. From the research methods we chose to the materials we used, we made sure to translate all of the materials to match each participant’s target language. This required the guidance of one of my teammates, who translated all of the content in the prototype into Chinese when we did usability testing.
We also made efforts to consider digital literacy inclusion: for participants who felt uncomfortable with remote testing session, we made provisions to ensure that someone can help them set up the digital interview environment.
I am so proud of our final prototype. Our goal was to bridge the gap in healthcare accessibility for non-native English speakers in the East Asian community, which is a significant endeavor that we approached with great devotion. Through this experience, I gained invaluable insights into the importance of addressing linguistic and cultural barriers in medical care.
Browse through the flows to view the key elements of the application.
Universally Accessible Patient Portal
FINAL PROTOTYPE
Positive Feedback
“It would allow me to describe my symptoms more accurately and get the care I need”.
“This app allows me to delegate roles to different family members and ensures that all parties involved have access to accurate medical information”.
“This avoids the need for me to memorize my treatment plans. It’s difficult to remember and communicate medical information or treatments I’ve had, so this really helps”.
Communication is Key
By immersing myself in the intricacies of healthcare accessibility for non-native English speakers in the East Asian community, I gained a profound understanding of the diverse struggles that individuals from different backgrounds might encounter.
Embracing diversity and inclusivity through UX
WHAT I’VE LEARNED
The Value of Cultural Considerations
Integrating cultural considerations into design involves navigating a nuanced landscape of traditions, beliefs, and preferences that vary among different user groups. This complexity requires understanding the cultural context deeply, ensuring that design choices resonate positively with the target audience without inadvertently perpetuating stereotypes or biases.
What I would do differently
The direct communication with the East Asian community (those who could not speak English) were primarily channeled through one team member due to language barriers with the rest of our team. To improve this aspect in the future, I would proactively seek ways to distribute the communication load more evenly. This could involve leveraging translation tools or enlisting bilingual community members to foster more direct and collaborative interactions, alleviating any undue pressure on a single member and promoting a more inclusive and well-rounded approach to engagement.